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Fetal haemoglobin and bronchopulmonary dysplasia in neonates : An observational study

Hellström, William ; Martinsson, Tobias ; Hellstrom, Ann ; Morsing, Eva LU and Ley, David LU (2021) In Archives of Disease in Childhood: Fetal and Neonatal Edition 106(1). p.88-92
Abstract

Objective: Early decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated. Design: Retrospective observational study. Setting: Tertiary level neonatal intensive care unit, referral centre for Southern Sweden. Patients: 452 very preterm infants (<30 gestational weeks) born 2009-2015. Interventions: Regular clinical practice. Main outcome measures: Mean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO2) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36... (More)

Objective: Early decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated. Design: Retrospective observational study. Setting: Tertiary level neonatal intensive care unit, referral centre for Southern Sweden. Patients: 452 very preterm infants (<30 gestational weeks) born 2009-2015. Interventions: Regular clinical practice. Main outcome measures: Mean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO2) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36 weeks' postmenstrual age) and the modifying influence of PaO2 (kPa) and total Hb (g/L) was evaluated. Results: The mean gestational age (GA) at birth was 26.4 weeks, and 213 (56%) infants developed BPD. A 10% increase in HbF was associated with a decreased prevalence of BPD, OR 0.64 (95% CI 0.49 to 0.83; p<0.001). This association remained when adjusting for mean PaO2 and Hb. Infants with an HbF in the lowest quartile had an OR of 27.1 (95% CI 11.6 to 63.4; p<0.001) for development of BPD as compared with those in the highest quartile. The area under the curve for HbF levels and development of BPD in the full statistical model was 0.871. Conclusions: Early rapid postnatal decline in HbF levels was associated with development of BPD in very preterm infants. The association between HbF and BPD was not mediated by increased oxygen exposure. The potential benefit of minimising loss of endogenous blood components on BPD outcome will be investigated in a multicentre randomised trial.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
neonatology, pathology, physiology
in
Archives of Disease in Childhood: Fetal and Neonatal Edition
volume
106
issue
1
pages
5 pages
publisher
BMJ Publishing Group
external identifiers
  • pmid:32847833
  • scopus:85090930665
ISSN
1359-2998
DOI
10.1136/archdischild-2020-319181
language
English
LU publication?
yes
id
1b8ae0ed-c5f5-4c0b-a61c-6c1e75a468f4
date added to LUP
2020-10-02 14:59:46
date last changed
2021-06-01 04:32:24
@article{1b8ae0ed-c5f5-4c0b-a61c-6c1e75a468f4,
  abstract     = {<p>Objective: Early decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated. Design: Retrospective observational study. Setting: Tertiary level neonatal intensive care unit, referral centre for Southern Sweden. Patients: 452 very preterm infants (&lt;30 gestational weeks) born 2009-2015. Interventions: Regular clinical practice. Main outcome measures: Mean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO2) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36 weeks' postmenstrual age) and the modifying influence of PaO2 (kPa) and total Hb (g/L) was evaluated. Results: The mean gestational age (GA) at birth was 26.4 weeks, and 213 (56%) infants developed BPD. A 10% increase in HbF was associated with a decreased prevalence of BPD, OR 0.64 (95% CI 0.49 to 0.83; p&lt;0.001). This association remained when adjusting for mean PaO2 and Hb. Infants with an HbF in the lowest quartile had an OR of 27.1 (95% CI 11.6 to 63.4; p&lt;0.001) for development of BPD as compared with those in the highest quartile. The area under the curve for HbF levels and development of BPD in the full statistical model was 0.871. Conclusions: Early rapid postnatal decline in HbF levels was associated with development of BPD in very preterm infants. The association between HbF and BPD was not mediated by increased oxygen exposure. The potential benefit of minimising loss of endogenous blood components on BPD outcome will be investigated in a multicentre randomised trial. </p>},
  author       = {Hellström, William and Martinsson, Tobias and Hellstrom, Ann and Morsing, Eva and Ley, David},
  issn         = {1359-2998},
  language     = {eng},
  number       = {1},
  pages        = {88--92},
  publisher    = {BMJ Publishing Group},
  series       = {Archives of Disease in Childhood: Fetal and Neonatal Edition},
  title        = {Fetal haemoglobin and bronchopulmonary dysplasia in neonates : An observational study},
  url          = {http://dx.doi.org/10.1136/archdischild-2020-319181},
  doi          = {10.1136/archdischild-2020-319181},
  volume       = {106},
  year         = {2021},
}