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Neonatal Follow-up

NICU Follow Up and Neurodevelopment 3: Impact of the Prenatal Environment on Development and Outcomes

228 - Association of the low hemoglobin at birth and neurodevelopmental outcomes in preterm neonates < 29 weeks’ gestation: A retrospective cohort study

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 228
Publication Number: 228.143

Mohamed AI. Elkhouli, The Hospital for Sick Children, Toronto, ON, Canada; Kamini Raghuram, Mount Sinai Hospital, Toronto, ON, Canada; Rudaina Banihani, University of Toronto / sunnybrook Health Science Centre, Toronto, ON, Canada; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada; Elizabeth Asztalos, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Adel Mohamed, Mount Sinai Hospital, Toronto, ON, Canada

Presenting Author(s)

ME

Mohamed AI Elkhouli, MD (he/him/his)

Assistant professor of Pediatrics
University of Toronto
Toronto, Ontario, Canada

Background: Low hemoglobin (Hb) at birth is not uncommon presentation for infants born preterm. The association of early anemia on the neurodevelopmental outcomes in extremely preterm infants is not well studied.

Objective: The objective of this study was to assess neurodevelopmental outcomes at 18-24 months corrected age (CA) of preterm infants with Hb < 120 gm/l compared to those with Hb ≥ 120 gm/l at birth.

Design/Methods: In this retrospective cohort study, infants of < 29 weeks’ gestational age (GA) with a Hb result at birth, and admitted to one of two Canadian tertiary care NICUs between January 2009 and June 2018 were included. Baseline sociodemographic, antenatal, and neonatal data were compared between groups. The primary outcome was neurodevelopmental impairment (NDI), defined as the presence of one or more of cerebral palsy; motor, cognitive, or language impairments on standardized testing; or visual or hearing impairment, at 18-24 months. Secondary outcomes included significant NDI (sNDI), death, severe retinopathy of prematurity (ROP) (≥ stage 3), grade III intraventricular hemorrhage (IVH), periventricular hemorrhagic infarction, bronchopulmonary dysplasia (BPD), and composite outcomes of death or NDI. Multivariable logistic regression adjusting for GA, small for GA (SGA), sex, birth center, and antenatal steroids, was used to determine the association between early anemia and outcomes.

Results:

Of the 2351 eligible neonates, 351 (14.9%) had Hb levels < 120 gm/L at birth. Baseline characteristics for groups are summarized in Table 1. Of the infants who survived, 1534 (72.5%) had developmental follow-up at 18 to 24 months CA. Low Hb was associated with significantly higher odds of NDI among survivors in univariate analyses but not in multivariable logistic regression (Table 2). The composite outcome of death or NDI was significantly higher in the low Hb group, primarily driven by the higher incidence of mortality. Neonatal death, IVH, ROP, and BPD were significantly higher in the low Hb group (Table 3).

Conclusion(s): In preterm infants of < 29 weeks’ GA, low Hb at birth was not associated with significant NDI outcomes at 18-24 months. However, low Hb was associated with higher odds of death, severe IVH, severe ROP, and BPD.