Delayed cord clamping in red blood cell alloimmunization: safe, effective, and free?

AbstractAnemia and thrombocytopenia occur frequently in preterm neonates and the majority of them require at least one blood transfusion during the first few weeks of life. However, there is no international consensus on optimal transfusion management neither for red blood cell nor for platelet transfusions, resulting in large worldwide variations in transfusion practices between neonatal intensive care units. In the past decade, several studies performed in adults, infants as well as neonates showed that restrictive transfusion guidelines are just as safe as liberal guidelines. In fact, some studies even showed that liberal guidelines could be associated with an increased risk of morbidity and mortality, suggesting that too many transfusions may have a deleterious effect. In a recent randomized trial in preterm neonates with thrombocytopenia, the liberal transfusion group (receiving more platelet transfusions) had a significantly higher rate of death or major bleeding than the restrictive group (receiving less transfusions). In preterm neonates with anemia, the available evidence is also limited and controversial. Two large randomized controlled trials (ETTNO and TOP) are currently assessing the safety and effectiveness of liberal versus restrictive red blood cell transfusions. Results of these large two studies, including the long-term neurodevelopment outcome, are eagerly awaited. Until then, reduction of anemia of prematurity by implementation of effective preventive measures, such as delayed cord clamping and minimization of iatrogenic blood loss, remain of paramount importance.

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Benefits of Delayed Cord Clamping in Red Blood Cell Alloimmunization

PEDIATRICS ◽

10.1542/peds.2015-3236 ◽

2016 ◽

Vol 137 (3) ◽

pp. e20153236 ◽

Cited By ~ 21

Author(s):

Charles Garabedian ◽

Thameur Rakza ◽

Elodie Drumez ◽

Marion Poleszczuk ◽

Louise Ghesquiere ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Delayed Cord Clamping ◽

Cord Clamping

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Haemoglobin and red blood cell reference intervals during infancy

Archives of Disease in Childhood ◽

10.1136/archdischild-2021-321672 ◽

2021 ◽

pp. archdischild-2021-321672

Author(s):

Sara Marie Larsson ◽

Lena Hellström-Westas ◽

Andreas Hillarp ◽

Pia Karlsland Åkeson ◽

Magnus Domellöf ◽

...

Keyword(s):

Blood Cell ◽

Umbilical Cord ◽

Red Blood Cell ◽

Haemoglobin Concentration ◽

Reference Intervals ◽

Mean Cell Volume ◽

Cord Clamping ◽

Healthy Infants ◽

Umbilical Cord Clamping ◽

Definition Of

ObjectivesThere is a need for updated haematological reference data in infancy. This study aimed to define intervals for haemoglobin and red blood cell biomarkers based on data from a large cohort of longitudinally followed Swedish infants.DesignLongitudinal cohort study.SettingTwo Swedish study centres.ParticipantsThree community-based populations including 442 presumably healthy infants born at term and with umbilical cord clamping delayed to 30 s or more after birth.MethodsBlood samples were collected from umbilical cord blood (a), at 48–118 hours (b), at 4 months (c) and at 12 months (d). Reference intervals as the 2.5th and 97.5th percentiles were calculated in coherence with Clinical and Laboratory Standards Institute guidelines.ResultsReference intervals for haemoglobin (g/L) were: (a) 116–189, (b) 147–218, (c) 99–130, (d) 104–134, and for mean cell volume (fL): (a) 97–118, (b) 91–107, (c) 71–85, (d) 70–83. Reference intervals for erythrocyte counts, reticulocyte counts, reticulocyte haemoglobin, mean cell haemoglobin and mean cell haemoglobin concentration were also estimated. According to the WHO definition of anaemia, a haemoglobin value less than 110 g/L, 16% of this presumably healthy cohort could be classified as anaemic at 12 months.ConclusionWe found mainly narrower reference intervals compared with previously published studies. The reference intervals for each parameter varied according to the infants’ age, demonstrating the necessity of age definitions when presenting infant reference intervals. The discrepancy with the WHO classification for anaemia at 12 months, despite favourable conditions in infancy, needs future investigation.

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