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The impact of initial hematocrit values after birth on peri-/intraventricular hemorrhage in extremely low birth weight neonates

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Abstract

Aim

Peri-/intaventricular hemorrhage (P/IVH) is a common condition in preterm neonates and is responsible for substantial adverse neurological outcome especially in extremely low birth weight infants. As hematocrit after birth is a surrogate marker for blood volume, this study aimed to evaluate the effect of initial hematocrit values after birth on P/IVH development in extreme low birth weight (ELBW) neonates.

Patients and methods

A prospective cohort analysis of 92 eligible ELBW neonates was performed. The relationship between initial hematocrit values in ELBW neonates after birth and subsequent development of P/IVH was examined.

Results

Twenty-nine of 92 infants developed P/IVH. There were significant differences in initial Hct and maximum carbon dioxide (max PCO2) in the first 3 days levels in the P/IVH group compared with no P/IVH group. Initial Hct level at birth in the P/IVH group were significantly lower than the no P/IVH group while max PCO2 in the first 3 days were found to be significantly high in the P/IVH group. There were no significant differences in other baseline demographic, perinatal, and neonatal characteristics while in univariate analysis, higher gestational age and initial Hct were associated with decreased likelihood of P/IVH. In multiple regression analysis after adjustment, only initial Hct remained significantly associated with P/IVH. There was no difference between the population by subgroups of IVH (IVH I–II and IVH III–IV) according to hematocrit and the severity of IVH.

Conclusion

Higher initial Hct at birth is associated with decreased P/IVH in ELBW infants. We hypothesized the argument that ELBW infants who have lower initial Hct at birth have less suboptimal volume status that predisposing lower cerebral blood flow and the resultant decrease in cerebral blood flow precede the development of P/IVH.

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References

  1. Payne AH, Hintz SR, Hibbs AM, Walsh MC, Vohr BR, Bann CM et al (2013) Neurodevelopmental outcomes of extremely low-gestational-age neonates with low-grade periventricular-intraventricular hemorrhage. JAMA Pediatr 167:451–459. https://doi.org/10.1001/jamapediatrics.2013.866

    Article  PubMed  PubMed Central  Google Scholar 

  2. Allen KA (2013) Treatment of intraventricular hemorrhages in premature infants: where is the evidence? Adv Neonatal Care 13:127–130. https://doi.org/10.1097/ANC.0b013e31828ac82e

    Article  PubMed  Google Scholar 

  3. Vohr B, Ment LR (1996) Intraventricular hemorrhage in the preterm infant. Early Hum Dev 44:1–16. https://doi.org/10.1016/0378-3782(95)01692-9

    Article  CAS  PubMed  Google Scholar 

  4. Horbar JD, Badger GJ, Carpenter JH et al (2002) Trends in mortality and morbidity for very low birth weight infants, 1991–1999. Pediatrics 110:143–151. https://doi.org/10.1542/peds.110.1.143

    Article  PubMed  Google Scholar 

  5. Bassan H (2009) Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol 36:737–762. https://doi.org/10.1016/j.clp.2009.07.014

    Article  PubMed  Google Scholar 

  6. Rabe H, Gyte G MI, Diaz-Rossello JL, Duley L (2019) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 9(9):CD003248. Published 2019 Sep 17. https://doi.org/10.1002/14651858.CD003248.pub4. https://doi.org/10.1002/14651858.CD003248.pub4

  7. Fogarty M, Osborn DA, Askie L, Seidler AL, Hunter K, Lui K et al (2018) Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 218:1–18. https://doi.org/10.1016/j.ajog.2017.10.231

    Article  PubMed  Google Scholar 

  8. Hemmati F, Sharma D, Namavar Jahromi B, Salarian L, Farahbakhsh N (2020) Delayed cord clamping for prevention of intraventricular hemorrhage in preterm neonates: a randomized control trial. J Matern Fetal Neonatal Med 22:1–7. https://doi.org/10.1080/14767058.2020.1836148

    Article  CAS  Google Scholar 

  9. Josephsen JB, Potter S, Armbrecht ES, Al-Hosni M (2020) Umbilical cord milking in extremely preterm infants: a randomized controlled trial comparing cord milking with immediate cord clamping. Am J Perinatol 7. https://doi.org/10.1055/s-0040-1716484. Epub ahead of print. PMID: 32894871

  10. Chu KS, Shah PS, Whittle WL, Windrim R, Murphy KE (2019) The “DUC” trial: a pilot randomized controlled trial of immediate versus delayed cord clamping in preterm infants born between 24 and 32 weeks gestation. J Matern Fetal Neonatal Med 25:1–4. https://doi.org/10.1080/14767058.2019.1702959. Epub ahead of print. PMID: 31875737

  11. Benders MJ, Kersbergen KJ, de Vries LS (2014) Neuroimaging of White matter injury, intraventricular and cerebellar hemorrhage. Clin Perinato 41:69–82. https://doi.org/10.1016/j.clp.2013.09.005

    Article  Google Scholar 

  12. Shaver DC, Bada HS, Korones SB, Anderson GD, Wong SP, Arheart KL (1992) Early and late intraventricular hemorrhage: the role of obstetric factors. Obstet Gynecol 80:831–837. PMID: 1407923

    CAS  PubMed  Google Scholar 

  13. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N, Turner P, Karmazyn B, Sirota L (2003) Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics 111:590–595. https://doi.org/10.1542/peds.111.5.e590

    Article  Google Scholar 

  14. Banerjee J, Asamoah FK, Singhvi D, Kwan AW, Morris JK, Aladangady N (2015) Haemoglobin level at birth is associated with short term outcomes and mortality in preterm infants. BMC Med 13:16. https://doi.org/10.1186/s12916-014-0247-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Dekom S, Vachhani A, Patel K, Barton L, Ramanathan R, Noori S (2018) Initial hematocrit values after birth and peri/intraventricular hemorrhage in extremely low birth weight infants. J Perinatol 38(11):1471–1475. https://doi.org/10.1038/s41372-018-0224-6. Epub 2018 Sep 11 PMID: 30206347

    Article  PubMed  Google Scholar 

  16. Backes CH, Rivera BK, Haque U, Bridge JA, Smith CV, Hutchon DJ, Mercer JS (2014) Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstat Gynecol 124:47–56. https://doi.org/10.1097/AOG.0000000000000324

    Article  Google Scholar 

  17. Strauss RG, Mock DM, Johnson KJ, Cress GA, Burmeister LF, Zimmerman MB, Bell EF, Rijhsinghani A (2008) A randomized clinical trial comparing immediate versus delayed clamping of the umblical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 48(4):658–665. https://doi.org/10.1111/j.1537-2995.2007.01589.x

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fariba H, Sharma D, Bahia NJ, Leila S, Farahbakhsh N (2020) Delayed cord clamping for prevention of intraventricular hemorrhage in preterm neonates: a randomized control trial. J Matern Fetal Neonatal Med 22:1–7. https://doi.org/10.1080/14767058.2020.1836148

    Article  CAS  Google Scholar 

  19. Rhee CJ, Fraser CD 3rd, Kibler K, Easley RB, Andropoulos DB, Czosnyka M, Varsos GV, Smielewski P, Rusin CG, Brady KM, Kaiser JR (2014) The ontogeny of cerebrovascular pressure autoregulation in human premature infants. J Perinatol 34(12):926–931. https://doi.org/10.1038/jp.2014.122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kluckow M, Evans N (2000) Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 82:182–187. https://doi.org/10.1136/fn.82.3.f182

    Article  Google Scholar 

  21. Kehrer M, Blumenstock G, Ehehalt S, Goelz R, Poets C, Schöning M (2005) Development of cerebral blood flow volume in preterm neonates during the first 2 weeks of life. Pediatr Res 58:927–930. https://doi.org/10.1203/01.PDR.0000182579.52820.C3

    Article  PubMed  Google Scholar 

  22. Kluckow M, Evans N (2000) Low superior vena cava flow and intraventricular hemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 82:188–194. https://doi.org/10.1136/fn.82.3.f188

    Article  Google Scholar 

  23. Kissack CM, Garr R, Wardle SP, Weindling AM (2004) Postnatal changes in cerebral oxygen extraction in the preterm infant are associated with intraventricular hemorrhage and hemorrhagic parenchymal infarction but not periventricular leukomalacia. Pediar Rews 56:111–116. https://doi.org/10.1203/01.PDR.0000128984.03461.42

    Article  Google Scholar 

  24. Roberts D, Brown J, Medley N, Dalziel SR (2017) Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 3(3):CD004454. https://doi.org/10.1002/14651858.CD004454.pub3. Update in: Cochrane Database Syst Rev. 2020 Dec 25 12:CD004454. PMID: 28321847; PMCID: PMC6464568

  25. Lim J, Hagen E (2019) Reducing germinal matrix-intraventricular hemorrhage: perinatal and delivery room factors. NeoReviews 20(8):e452–e463. https://doi.org/10.1542/neo.20-8-e452. PMID: 31371554

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Health Sciences, Gulhane Medicine Faculty, Department of Pediatrics, Division of Neonatology, Ankara, Turkey

    Belma Saygili Karagol & Erhan Calisici

  2. University of Health Sciences, Gulhane Medicine Faculty, Department of Pediatrics, Ankara, Turkey

    Cengiz Zeybek

  3. University of Health Sciences, Gulhane Medicine Faculty, Department of Pediatrics, Division of Pediatric Neurology, Ankara, Turkey

    Bulent Unay

  4. Yıldırım Beyazıt University of Medicine Faculty, Department of Biostatistics, Ankara, Turkey

    Selcen Yuksel

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  1. Belma Saygili Karagol
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  2. Erhan Calisici
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Correspondence to Belma Saygili Karagol.

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Karagol, B.S., Calisici, E., Zeybek, C. et al. The impact of initial hematocrit values after birth on peri-/intraventricular hemorrhage in extremely low birth weight neonates. Childs Nerv Syst 38, 109–114 (2022). https://doi.org/10.1007/s00381-021-05398-z

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  • DOI: https://doi.org/10.1007/s00381-021-05398-z

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