Morbidity Associated with Early Neonatal Anemia in Preterm and Term Infants: An Observational Study with Propensity Score Matching

Abstract Introduction: Anemia in preterm infants is associated with neonatal morbidity outcomes, such as intraventricular hemorrhage (IVH), necrotizing enterocolitis, and bronchopulmonary dysplasia. This study aimed to describe the prevalence of early neonatal anemia (ENA) and evaluate the morbidity and mortality in preterm and term infant. Methods: We conducted a single-center case-control study among a cohort of 1,603 inborn infants admitted in our neonatal medicine department between June 2017 and April 2021. We included 115 infants with ENA defined as first hemoglobin level <14 g/dL. A control group of 115 infants were matched using a propensity score. Results: The median hemoglobin at admission value was of 12.3 g/dL for cases and 17.3 g/dL for controls. Cases with ENA needed more cardiopulmonary resuscitation in the delivery room (OR 4.7; 95% CI: 2.1–12.3) and mechanical ventilation (OR 2.4; 95% CI: 1.4–4.2). ENA was significantly associated with circulatory failure requiring aminergic support (OR 3.2; 95% CI: 1.5–7), transfusion (OR 11; 95% CI: 4.4–32.6), and volume expansion (OR 4.7; 95% CI: 2.2–11). Hemodynamically significant patent ductus arteriosus and IVH (OR 3; 95% CI: 1.5–6.3) are significantly increased in the anemia group. Conclusion: ENA is significantly associated with severe hemodynamics, respiratory and neurological morbidities. These complications seem to occur during the adaptation to the extrauterine life. Early peripartum detection of anemia should be investigated in further studies. Plain Language Summary This retrospective observational study explores the association between early neonatal anemia (ENA) and adverse clinical outcomes in preterm and term infants which is an under-investigated subject with significant implications for current clinical practice. Among 1,603 newborns admitted between 2017 and 2021, 115 infants with ENA were matched to 115 controls using propensity score matching to improve the robustness of comparisons. We studied the prevalence of ENA in our institution as well as associated mortality and morbidities, especially hemodynamic, respiratory, and neurological morbidities.

• Publication year

  2025

• Venue

  Maternal and Children's Health

• Publication date

  2025-11-06

• Fields of study

  Not labeled

• Identifiers
  DOI 10.1159/000549103
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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  2021influential reference
• Red cell transfusion thresholds for preterm infants: finally some answers

  2021cited by this paper
• Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates

  2020cited by this paper
• The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach

  2019cited by this paper
• The contribution of red blood cell transfusion to neonatal morbidity and mortality

  2019cited by this paper
• Early anemia and neonatal morbidity in extremely low birth-weight preterm infants

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• Perinatal Anemia is Associated with Neonatal and Neurodevelopmental Outcomes in Infants with Moderate to Severe Perinatal Asphyxia

  2018influential reference
• Optimising Intravenous Volume Resuscitation of the Newborn in the Delivery Room: Practical Considerations and Gaps in Knowledge

  2017cited by this paper
• Abstention or intervention for isolated hypotension in the first 3 days of life in extremely preterm infants: association with short-term outcomes in the EPIPAGE 2 cohort study

  2017cited by this paper
• Fetal Physiology and the Transition to Extrauterine Life.

  2016cited by this paper
• Haemoglobin level at birth is associated with short term outcomes and mortality in preterm infants

  2015influential reference
• Perinatal factors in patent ductus arteriosus in very low‐birthweight infants

  2014cited by this paper
• Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.

  2012cited by this paper
• Pathophysiology of Anemia During the Neonatal Period, Including Anemia of Prematurity.

  2008cited by this paper
• Effect of hemoglobin on transfusion and neonatal adaptation in extremely low‐birthweight infants

  2008influential reference
• A Systematic Review and Meta-Analysis of a Brief Delay in Clamping the Umbilical Cord of Preterm Infants

  2007cited by this paper
• Long-Term Prognosis for Infants After Massive Fetomaternal Hemorrhage

  2007cited by this paper
• Prediction of transfusions in extremely low‐birthweight infants in the erythropoietin era

  2006cited by this paper
• Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study.

  2003cited by this paper
• Staging of Twin-Twin Transfusion Syndrome

  1999cited by this paper
• Assessment of anemia in newborn infants.

  1984cited by this paper
• Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm.

  1978cited by this paper
• Anemia of prematurity.

  1977cited by this paper

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