BACKGROUND: Perinatal anemia may cause perinatal asphyxia. Its pathophysiology and neurodevelopmental effects are theoretically different from other causes of perinatal asphyxia. OBJECTIVE: The study aimed to determine whether perinatal anemia results in different short-term and long-term outcomes than other causes of perinatal asphyxia treated with therapeutic hypothermia. METHODS: We retrospectively included infants with moderate to severe hypoxic-ischemic encephalopathy, born between May 2009 and October 2015. During follow-up, we assessed cognitive and motor development at 2-3 years of age, using the Bayley Scales of Infant and Toddler Development, third edition (BSID-III). Neurodevelopmental outcome (NDO) was classified as abnormal in case of cerebral palsy with Gross Motor Function Classification System ≥III and/or a BSID-III composite score < 85. Outcomes of infants with perinatal anemia (initial hemoglobin < 7 mmol/L) were compared to infants born with perinatal asphyxia due to other causes. RESULTS: In total, 111 infants were included of whom 30 infants (27%) died during the neonatal period. Infants with anemia (n = 23) had a higher mortality risk, OR 3.33, 95% CI 1.27-8.72, p = 0.01. None of the surviving infants with anemia (n = 12) had an abnormal NDO, in contrast to 26/69 (38%) with neurodevelopmental impairments, particularly motor problems, in the non-anemic group, p < 0.01. CONCLUSIONS: Perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. All survivors with perinatal anemia, however, showed a normal NDO in contrast to children who were born asphyxiated due to other causes. The underlying pathophysiological mechanism for the favorable NDO in the perinatal anemia group needs further elucidation.
BACKGROUND: Perinatal anemia may cause perinatal asphyxia. Its pathophysiology and neurodevelopmental effects are theoretically different from other causes of perinatal asphyxia. OBJECTIVE: The study aimed to determine whether perinatal anemia results in different short-term and long-term outcomes than other causes of perinatal asphyxia treated with therapeutic hypothermia. METHODS: We retrospectively included infants with moderate to severe hypoxic-ischemicencephalopathy, born between May 2009 and October 2015. During follow-up, we assessed cognitive and motor development at 2-3 years of age, using the Bayley Scales of Infant and Toddler Development, third edition (BSID-III). Neurodevelopmental outcome (NDO) was classified as abnormal in case of cerebral palsy with Gross Motor Function Classification System ≥III and/or a BSID-III composite score < 85. Outcomes of infants with perinatal anemia (initial hemoglobin < 7 mmol/L) were compared to infants born with perinatal asphyxia due to other causes. RESULTS: In total, 111 infants were included of whom 30 infants (27%) died during the neonatal period. Infants with anemia (n = 23) had a higher mortality risk, OR 3.33, 95% CI 1.27-8.72, p = 0.01. None of the surviving infants with anemia (n = 12) had an abnormal NDO, in contrast to 26/69 (38%) with neurodevelopmental impairments, particularly motor problems, in the non-anemic group, p < 0.01. CONCLUSIONS: Perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. All survivors with perinatal anemia, however, showed a normal NDO in contrast to children who were born asphyxiated due to other causes. The underlying pathophysiological mechanism for the favorable NDO in the perinatal anemia group needs further elucidation.
Authors: Floris Groenendaal; Alexandra Casaer; Koen P Dijkman; Antonio W D Gavilanes; Timo R de Haan; Henk J ter Horst; Sabine Laroche; Gunnar Naulaers; Monique Rijken; Henrica L M van Straaten; Katerina Steiner; Renate M C Swarte; Alexandra Zecic; Inge A Zonnenberg Journal: Neonatology Date: 2013-04-23 Impact factor: 4.035
Authors: Janneke L M Bruggink; Christa Einspieler; Phillipa R Butcher; Elisabeth F Stremmelaar; Heinz F R Prechtl; Arend F Bos Journal: Early Hum Dev Date: 2008-08-08 Impact factor: 2.079
Authors: Linda G M van Rooij; Mona C Toet; Alexander C van Huffelen; Floris Groenendaal; Wijnand Laan; Alexandra Zecic; Timo de Haan; Irma L M van Straaten; Sabine Vrancken; Gerda van Wezel; Jaqueline van der Sluijs; Henk Ter Horst; Danilo Gavilanes; Sabrina Laroche; Gunnar Naulaers; Linda S de Vries Journal: Pediatrics Date: 2010-01-25 Impact factor: 7.124
Authors: Denis Azzopardi; Brenda Strohm; Neil Marlow; Peter Brocklehurst; Aniko Deierl; Oya Eddama; Julia Goodwin; Henry L Halliday; Edmund Juszczak; Olga Kapellou; Malcolm Levene; Louise Linsell; Omar Omar; Marianne Thoresen; Nora Tusor; Andrew Whitelaw; A David Edwards Journal: N Engl J Med Date: 2014-07-10 Impact factor: 91.245