DOCSLIB.ORG

Neonatal Transfusion Practice N a Murray, I a G Roberts

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Neonatal Transfusion Practice N a Murray, I a G Roberts F101 Arch Dis Child Fetal Neonatal Ed: first published as 10.1136/adc.2002.019760 on 1 March 2004. Downloaded from PERSONAL PRACTICE Neonatal transfusion practice N A Murray, I A G Roberts ............................................................................................................................... Arch Dis Child Fetal Neonatal Ed 2004;89:F101–F107. doi: 10.1136/adc.2002.019760 Many previously widely accepted neonatal transfusion However, neither clinical situation is straight- forward to define. practices are changing as neonatologists become more aware of the risks to their patients of multiple blood product Tissue oxygenation Ensuring adequate tissue oxygen delivery transfusions. Recent literature and research on neonatal Tissue oxygenation is influenced by the concen- transfusion practice are here reviewed, and practical tration and type of haemoglobin (Hb), the guidelines and trigger thresholds for blood products concentration of 2,3-diphosphoglycerate within RBCs (both factors affect the Hb-oxygen dis- commonly used in neonatal medicine are proposed. sociation curve and thus the oxygen unloading ........................................................................... capacity of the blood), and the cardiopulmonary function of the neonate. Apart from Hb concen- ick neonates are one of the most heavily tration, none of these variables are easily transfused groups of patients in modern measurable in everyday neonatal practice. In Smedicine. However, despite considerable addition, assuming optimised cardiopulmonary research, most neonatal transfusion practice function during intensive care, apart from alter- remains opinion based rather than truly evidence ing Hb concentration by transfusion (and based. Most neonatologists would not prescribe thereby Hb type and 2,3-diphosphoglycerate drugs to their patients unless there was a concentration by exchanging HbF for HbA reasonable expectation of benefit. RBCs), little can be done to influence these Unfortunately, this rigour does not translate to variables on an hour to hour or day to day basis. the prescription of blood products, and as a result Thus RBC transfusion remains the only ‘‘haema- there exists a diversity of opinion and practice tological’’ treatment option available that has the copyright. between different clinicians1 and different insti- potential to significantly influence tissue oxygen tutions.2–6 Clearly the administration of blood delivery. However, the question remains how to products conveys a finite risk of transmitting recognise when a neonate is developing Hb potentially serious infections7–9 and is not with- limited oxygen unloading capacity to the tissues out risk and cost.78 It therefore remains a and how to measure this accurately in everyday continuing task to define and refine the most practice? clinically appropriate protocols for blood product use in neonates, within the constraints of the Methods of assessing tissue oxygenation available evidence. With these goals in mind this Peripheral fractional oxygen extraction (FOE) paper reviews recent literature and research on Direct measurement of tissue oxygenation is not possible. However, surrogate measures have been neonatal transfusion practice and proposes prac- 12 tical transfusion guidelines and trigger thresh- attempted. Recently, Wardle et al measured olds for commonly used blood products in peripheral FOE by near infrared spectroscopy as http://fn.bmj.com/ neonatal medicine. a surrogate measure of the adequacy of tissue oxygen delivery in 74 neonates , 1500 g under- going standard neonatal care. High peripheral RED BLOOD CELLS FOE (. 0.47) was taken as a cut off point Packed red blood cells (RBCs) are the most suggesting inadequate tissue oxygen delivery and common blood product administered to sick thereby the potential for inadequate tissue neonates. Many previous studies (reviewed in oxygenation. This parameter was used as an on September 29, 2021 by guest. Protected refs10 11) have attempted to define their optimal RBC transfusion trigger in 37 neonates, with the use in neonates. However, rapidly changing remaining 37 neonates receiving RBC transfu- patient populations and characteristics over sion guided by a conventional Hb based protocol. the last decade, coupled with the introduction Although there was a trend towards fewer RBC of increasingly rigorous transfusion protocols, transfusions in the FOE group, this was not See end of article for have reduced the relevance of much of this significant. However, neonates in the FOE group authors’ affiliations ....................... previous work to modern neonatal practice. had lower median Hb during the study, and time Progress in RBC transfusion practice therefore Correspondence to: requires a fundamental re-evaluation of its basic Dr Murray, Imperial aims. ................................................... College, Faculty of Medicine, Hammersmith At the most basic level, RBC transfusions are Abbreviations: BCSH, British Committee for Standards in Campus, Hammersmith required for two reasons: Haematology; CLD, chronic lung disease of prematurity; Hospital, Du Cane Road, DIC, disseminated intravascular coagulation; FFP, fresh London W12 0NN, UK; N to ensure adequate tissue oxygenation during frozen plasma; FOE, fractional oxygen extraction; HAS, [email protected] intensive care periods human albumin solution; Hb, haemoglobin; IVH, intraventricular haemorrhage; NEC, necrotising Accepted 12 July 2003 N after intensive care, to treat clinically signifi- enterocolitis; NHI, normal human immunoglobulin; RBC, ....................... cant symptomatic anaemia red blood cell; rhEPO, recombinant human erythropoietin www.archdischild.com F102 Murray, Roberts Arch Dis Child Fetal Neonatal Ed: first published as 10.1136/adc.2002.019760 on 1 March 2004. Downloaded from to first transfusion from study entry was also longer. No Guidelines for transfusion of RBCs difference in major neonatal complications was seen between Taking into consideration the available evidence, we use the the two groups, suggesting that no clinical compromise following RBC transfusion practice in neonates. occurred in the neonates in the FOE group. Interestingly, two thirds of transfusions in the FOE group were given because of Packed RBC product clinical concerns about low Hb or symptoms and not because The British Committee for Standards in Haematology (BCSH) of high FOE. Thus, this method of assessing trigger thresh- Transfusion Task Force23 recommends the following. olds for RBC transfusion in preterm neonates deserves further assessment, as sticking closely to high FOE as a N Components for transfusion in utero or to children under transfusion trigger may prove to be a practical method to 1 year of age must be prepared from donors who have further reduce RBC transfusions and donor exposure without given at least one donation within the previous two years adversely affecting outcome. that was negative for all mandatory microbiological markers. Capillary whole blood lactate N Dedicating aliquots from a single donation to allow Lactate concentration has also been assessed as an indicator sequential transfusions from the same donor for neo- of tissue oxygenation and/or the need for RBC transfusion.13– nates/small children who are likely to be repeatedly 16 In the intensive care period, lactate concentrations are transfused is considered good practice. highly variable, probably reflecting variations in tissue N Components transfused in the first year of life should be perfusion rather than Hb limited oxygen unloading capacity cytomegalovirus seronegative (since November 2001 all to the tissues. Therefore, during intensive care, lactate cellular blood products in the United Kingdom have been concentrations are not useful in deciding the need for RBC leucocyte depleted before hospital issue and are widely transfusion. In stable neonates, these concentrations have regarded as cytomegalovirus safe; nevertheless, in the been shown to decrease after RBC transfusions given for 13 15 16 absence of controlled trials, the BCSH continues to ‘‘symptomatic’’ anaemia. However, even in stable recommend cytomegalovirus negative products for preterm neonates, lactate concentrations show considerable infants). variation during a 24 hour period,13 and before transfusion they do not correlate with Hb or packed cell volume.13 Thus, For a full discussion of recommendations for blood peripheral blood lactate concentrations may be useful in the components for use in the newborn, the reader is referred overall assessment of tissue perfusion/oxygenation, but on to the BCSH guidelines web site.23 their own are not a reliable indicator of the need for RBC transfusion. Dose (volume) of RBCs In summary, with currently available techniques, there is In preterm neonates the small amount of research available no practical method applicable to everyday neonatal practice suggests that large volume (20 ml/kg) RBC transfusions lead copyright. that accurately and reproducibly assesses tissue oxygenation. to larger rises in Hb and fewer overall transfusions than small volume transfusions (10 ml/kg).24 This volume of packed Trends in clinical practice RBCs is well tolerated in the vast majority of preterm As high quality methods for assessing tissue oxygenation are neonates.24 not available, observational clinical studies of RBC transfu- sion practice represent the best available evidence to guide Triggers for RBC transfusion future developments. Over the past 15 years, a number of Adhering
Load more

Recommended publications
  • Very Low Birth Weight Infants
    Intensive Care Nursery House Staff Manual Very Low and Extremely Low Birthweight Infants INTRODUCTION and DEFINITIONS: Low birth weight infants are those born weighing less than 2500 g. These are further subdivided into: •Very Low Birth Weight (VLBW): Birth weight <1,500 g •Extremely Low Birth Weight (ELBW): Birth weight <1,000 g Obstetrical history (LMP, sonographic dating), newborn physical examination, and examination for maturational age (Ballard or Dubowitz) are critical data to differentiate premature LBW from more mature growth-retarded LBW infants. Survival statistics for ELBW infants correlate with gestational age. Morbidity statistics for growth-retarded VLBW infants correlate with the etiology and the severity of the growth-restriction. PREVALENCE: The rate of VLBW babies is increasing, due mainly to the increase in prematurely-born multiple gestations, in part related to assisted reproductive techniques. The distribution of LBW infants is shown in the Table: ________________________________________________________________________ Table. Prevalence by birth weight (BW) of LBW babies. Percentage of Percentage of Births Birth Weight (g) Total Births with BW <2,500 g <2,500 7.6% 100% 2,000-2,500 4.6% 61% 1,500-1,999 1.5% 20% 1,000-1,499 0.7% 9.5% 500-999 0.5% 7.5% <500 0.1% 2.0% ________________________________________________________________________ CAUSES: The primary causes of VLBW are premature birth (born <37 weeks gestation, and often <30 weeks) and intrauterine growth restriction (IUGR), usually due to problems with placenta, maternal health, or to birth defects. Many VLBW babies with IUGR are preterm and thus are both physically small and physiologically immature. RISK FACTORS: Any baby born prematurely is more likely to be very small.
    [Show full text]
  • Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes
    ORIGINAL CONTRIBUTION Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes Lee C. Yang, DO; Donald R. Taylor, DO; Howard H. Kaufman, DO; Roderick Hume, MD; Byron Calhoun, MD The authors retrospectively evaluated maternal and fetal reterm premature rupture of membranes (PROM) at outcomes of 73 consecutive singleton pregnancies com- P16 through 26 weeks of gestation complicates approxi- plicated by preterm premature rupture of amniotic mem- mately 1% of pregnancies in the United States and is associ- branes. When preterm labor occurred and fetuses were at ated with significant risk of neonatal morbidity and mor- tality.1,2 a viable gestational age, pregnant patients were managed Perinatal mortality is high if PROM occurs when fetuses aggressively with tocolytic therapy, antenatal corticos- are of previable gestational age. Moretti and Sibai 3 reported teroid injections, and antenatal fetal testing. The mean an overall survival rate of 50% to 70% after delivery at 24 to gestational age at the onset of membrane rupture and 26 weeks of gestation. delivery was 22.1 weeks and 23.8 weeks, respectively. The Although neonatal morbidity remains significant, latency from membrane rupture to delivery ranged despite improvements in neonatal care for extremely pre- from 0 to 83 days with a mean of 8.6 days. Among the mature newborns, neonatal survival has improved over 73 pregnant patients, there were 22 (30.1%) stillbirths and recent years. Fortunato et al2 reported a prolonged latent phase, low infectious morbidity, and good neonatal out- 13 (17.8%) neonatal deaths, resulting in a perinatal death comes when physicians manage these cases aggressively rate of 47.9%.
    [Show full text]
  • Use of Blood Components in the Newborn
    NNF Clinical Practice Guidelines Use of Blood Components in the Newborn Summary of recommendations • Transfusion in the newborn requires selection of appropriate donor, measures to minimize donor exposure and prevent graft versus host disease and transmission of Cytomegalovirus. • Component therapy rather than whole blood transfusion, is appropriate in most situations. • A clear cut policy of cut-offs for transfusions in different situations helps reduce unnecessary exposure to blood products. • Transfusion triggers should be based on underlying disease, age and general condition of the neonate. Writing Group : Chairperson: Arvind Saili ; Members: RG Holla, S Suresh Kumar Reviewers: Neelam Marwaha, Ruchi Nanawati Page | 129 Downloaded from www.nnfpublication.org NNF Clinical Practice Guidelines Introduction Blood forms an important part of the therapeutic armamentarium of the neonatologist. Very small premature neonates are amongst the most common of all patient groups to receive extensive transfusions. The risks of blood transfusion in today’s age of rigid blood banking laws, while infrequent, are not trivial. Therefore, as with any therapy used in the newborn, it is essential that one considers the risk- benefit ratio and strive to develop treatment strategies that will result in the best patient outcomes. In addition, the relatively immature immune status of the neonate predisposes them to Graft versus Host Disease (GVHD), in addition to other complications including transmission of infections, oxidant damage, allo- immunization and
    [Show full text]
  • Transitioning Newborns from NICU to Home: Family Information Packet
    Transitioning Newborns from NICU to Home Family Information Packet Your Health Coach has prepared this information packet for your family to help explain the medical needs of your newborn as you prepare to leave the hospital. A Health Coach helps families/ caregivers adjust to working directly with the health care providers as well as increasing your ability and confidence to care for your infant. When infants are born before their due date or with health problems, families often need help managing their baby’s health care after leaving the hospital. Since they spend the first part of their lives in the hospital, the babies and their families may find it helpful to have extra support. Your Health Coach will work with your family to teach you to care for your infant, connect with the right doctors and specialists for treatment, and find resources in your area. The role of the Health Coach is as an educator, not as a caregiver. Planning must start before hospital discharge and continue through followup with the primary care provider. After discharge from the hospital, your infant’s care must be well coordinated and clearly communicated to avoid medical errors that could harm the baby. After your infant is discharged, your Health Coach should follow up with you by phone within a few days to make sure the transition is going well. Your Health Coach will want to know how your baby is doing, whether you have any questions or concerns, if your infant has been to the scheduled appointments, etc. This information packet contains tips for getting care, understanding signs and symptoms of illness, medicines and immunizations, managing breathing problems, and feeding.
    [Show full text]
  • Ped9. Perinatal Period.Pdf
    PERINATAL PERIOD Ped9 (1) Perinatal Period Last updated: April 21, 2019 DELIVERY ROOM ..................................................................................................................................... 1 EVALUATION ......................................................................................................................................... 1 POSTDELIVERY CARE .............................................................................................................................. 2 URINATION ............................................................................................................................................ 2 CIRCUMCISION ....................................................................................................................................... 2 DEFECATION .......................................................................................................................................... 2 PREMATURITY ......................................................................................................................................... 2 POSTDATISM, POSTMATURITY ................................................................................................................ 4 SMALL-FOR-GESTATIONAL-AGE (SGA, DYSMATURITY, INTRAUTERINE GROWTH RESTRICTION, IUGR) ...................................................................................................................................................... 4 LARGE-FOR-GESTATIONAL-AGE (LGA) ...............................................................................................
    [Show full text]
  • 6/11/2019 1 “Lab Called… Your CBC Clotted”
    6/11/2019 Neonatal Lab Interpretation Tanya Hatfield, MSN, RNC - NIC UCSF Benioff Children’s Outreach Services “Lab called… your CBC clotted” 2 Objectives ▪ Interpret lab values ▪ Discuss jaundice of the newborn ▪ Understand specific hematologic problems 3 1 6/11/2019 CBC - Hematopoiesis 4 Erythrocytes - RBCs ▪ Main protein is hemoglobin ( Hgb ) ▪ RBC function is to protect Hgb ▪ Hgb function is oxygen/CO2 transport Reticulocytes ▪ Inversely proportional to GA at birth ▪ Falls quickly to less than 2% by 7 days ▪ Elevated early Retic Ct may indicate bleeding, hemolysis or chronic blood loss 5 Kenner, C. (2014). Comprehensive neonatal nursing care (Fifth ed., pp. 334 - 338) Components of CBC ▪ Main protein is hemoglobin (Hgb) ▪ RBC function is to protect Hgb ▪ Hgb function is oxygen/CO2 transport Reticulocytes ▪ Inversely proportional to GA at birth ▪ Falls quickly to less than 2% by 7 days ▪ Elevated early Retic Ct may indicate bleeding, hemolysis or chronic blood loss 6 Kenner, C. (2014). Comprehensive neonatal nursing care (Fifth ed., pp. 334 - 338) 2 6/11/2019 RBC Indices ▪ Mean corpuscular volume (MCV): size and volume ▪ Mean corpuscular hemoglobin (MCH): average amount (weight) of hemoglobin ▪ Mean corpuscular hemoglobin concentration (MCHC): average concentration ▪ Nucleated RBC: circulating pre - reticulocyte 7 Kenner, C. (2014). Comprehensive neonatal nursing care (Fifth ed., pp. 334 - 338) Anemia ▪ Differential • ↓ Erythrocyte production ‒ infection, nutritional deficiencies, leukemia, bone marrow failure, anemia of prematurity
    [Show full text]
  • Pepid Pediatric Emergency Medicine Clinical Topics
    PEPID PEDIATRIC EMERGENCY MEDICINE CLINICAL TOPICS NEONATOLOGY • CEPHAL HEMATOMA • CYSTIC FIBROSIS • ABDOMINAL AND CHEST WALL • CEREBRAL PALSY • CYTOMEGALOVIRUS (CMV) DEFECTS (NEONATE AND INFANT) • CHRONIC NEONATAL LUNG • DELAYED TRANSITION • ABNORMAL HEAD SHAPE DISEASE • DRUG EXPOSED INFANT • ABO-INCOMPATIBILITY • COMNGENITAL PARVOVIRUS B 19 • ERYTHROBLASTOSIS FETALIS • ACNE - INFANTILE • CONGENITAL CANDIDIASIS • EXAMINATION OF THE NEWBORN • ALIGILLE SYNDROME • CONGENITAL CATARACTS • EXCHANGE TRANSFUSION • AMBIGUOUS GENITALIA • CONGENITAL CMV • EYE MISALIGNMENT • AMNIOTIC FLUID ASPIRATION • CONGENITAL COXSACKIEVIRUS • FETAL HYDRONEPHROSIS • ANAL ATRESIA • CONGENITAL DYSERYTHROPOIETIC • FETOMATERNAL TRANSFUSION • ANEMIA - SEVERE AT BIRTH ANEMIA • FFEDS/FLUIDS - PRETERM • ANEMIA OF PREMATURITY • CONGENITAL EMPHYSEMA • FPIES(FOOD PROTEIN INDUCED • ANHYDRAMNIOS SEQUENCE • CONGENITAL GLAUCOMA ENTEROCOLITIES SYNDROME) • APGAR SCORE • CONGENITAL GOITER • GASTRO INTESTINAL REFLUX • APNEA OF PREMATURITY • CONGENITAL HEART BLOCK • GROUP B STREPTOCOCCUS • APT TEST • CONGENITAL HEPATIC FIBROSIS • HEMORRHAGIC DISEASE OF THE • ASPHYXIATING THORACIC DYSTRO- • CONGENITAL HEPATITIS B NEWBORN PHY (JEUNE SYNDROME) INFECTION • HEPATIC RUPTURE • ATELECTASIS • CONGENITAL HEPTITIS C • HIV • ATRIAL SEPTAL DEFECTS INFECTION • HYALINE MEMBRANE DISEASE • BARLOW MANEUVER • CONGENITAL HYDROCELE • HYDROCEPHALUS • BECKWITH-WIEDEMANN SYN- • CONGENITAL HYPOMYELINATING • HYDROPS FETALIS DROME • CONGENITAL HYPOTHYROIDISM • HYPOGLYCEMIA OF INFANCY • BENIGN FAMILIAL NEONATAL
    [Show full text]
  • European Society for Paediatric Research Annual Meeting Abstracts Bilbao, Spain September 27–30, 2003
    0031-3998/03/5404-0557 PEDIATRIC RESEARCH Vol. 54, No. 4, 2003 Copyright © 2003 International Pediatric Research Foundation, Inc. Printed in U.S.A. EUROPEAN SOCIETY FOR PAEDIATRIC RESEARCH ANNUAL MEETING ABSTRACTS BILBAO, SPAIN SEPTEMBER 27–30, 2003 0008NEO 0011NEO PRESCHOOL OUTCOME IN CHILDREN BORN VERY PREMATURELY EFFICACY OF ERYTHROPOITIN IN PREMATURE INFANTS AND CARED FOR ACCORDING TO NIDCAP Adnan Amin, Daifulah Alzahrani Bjo¨rn Westrup1, Birgitta Bo¨hm1, Hugo Lagercrantz1, Karin Stjernqvist2 Alhada Military Hospital City:Taif, Saudi Arabia 1Neonatal Programme, Dept. of Woman and Child Health, Astrid Lindgren Children’s Hospital, Objective: To identify the effect of early of parentral recombinant human erythropoitin (r-HuEPO) Karolinska Institute, Stockholm, Sweden;2Depts. of Psychology and of Paediatrics, University of and iron administration on blood transfusion requirement of premature infants. Methods: In a Lund, Sweden City: Stockholm and Lund, Sweden controlled clinical trial conducted at the Neonatal Intensive Care Unit, Al-Hada Military Hospital, Background/aim: Care based on the Newborn Individualized Developmental Care and Assess- Taif, Kingdom of Saudi Arabia over a 16 month period. We assigned 20 very low birth weight infants ment Program (NIDCAP) has been reported to exert a positive impact on the development of (VLBW) with gestational age of (mean Ϯ SEM 28.4 Ϯ 0.5 weeks and birth weight of (mean Ϯ SEM prematurely born infants. The aim of the present investigation was to determine the effect of such care 1031 Ϯ 42 gm), to receive either intravenous (r-HuEPO 200 U/kg/day) and iron 1mg/kg/day or on the development at preschool age of children born with a gestational age of less than 32 weeks.
    [Show full text]
  • AAP-Section on Perinatal Pediatrics
    Abstracts &&&&&&&&&&&&&& AAP-Section on Perinatal Pediatrics 1. INTRACELLULAR ADHESION MOLECULE ONE (ICAM-1) IS expression of the inflammatory adhesion molecule, ICAM-1. This INCREASED IN THE CLARA CELL SECONDARY TO EXPOSURE TO supports the premise that the Clara cell may function to modulate LPS, TNF , AND HYPEROXIA pulmonary inflammation by either the secretion of the anti- W.D. Clark1, S.E. Welty2 and P.L. Ramsay3; 1Pediatrics, inflammatory protein, CCSP, or by the expression of the pro- Baylor College of Medicine, Houston, TX, 2Pediatrics, inflammatory protein, ICAM-1. These data further suggest that Children’s Research Institute, Columbus, OH, potential therapeutic interventions that modulate the gene expression 3Pediatrics and Molecular and Cell Biology, Baylor within the Clara cell may provide a method to regulate pulmonary College of Medicine, Houston, TX inflammation. Purpose. Early lung inflammation in prematurely born newborns 2. GENETIC ENHANCEMENT OF GLUTATHIONE REDUCTASE results from a variety of exposures, including cytokines and hyperoxia. Previously, we have shown that serum levels of the PROTECTS CHINESE HAMSTER OVARY CELLS FROM HYPOXANTHINE/ inflammatory adhesion molecule, ICAM-1, are higher in infants XANTHINE OXIDASE–MEDIATED OXIDANT STRESS that develop BPD than in infants that do not. In addition, the D.J. O’Donovan, R.C. Husser, T. Tamura and C.J. content of an anti-inflammatory tracheal fluid protein secreted by Fernandes; Pediatrics, Baylor College of Medicine, the Clara cell, the Clara cell secretory protein (CCSP), is decreased Houston, TX in infants that develop BPD, whereas others have shown that the level of tracheal fluid ICAM-1 is increased. Therefore, this study was Purpose.
    [Show full text]
  • Newnorn Babies (Nb)
    ا.د نعمان نافع الحمداني Professor Numan Nafie Hameed NEWNORN BABIES (NB) Neonatal period: It is the first 4 weeks of human life (28 days). It is divided into: Early Neonatal period: is the first week of life (7 days) Late Neonatal period: > 7- 28 days of life Perinatal mortality rate (PMR): Is the number of still born babies after 20 weeks of gestation + number of deaths in the first week of life per 1000 total births. Neonatal mortality rate (NMR): Is the number of infants died during the first 28 days of life per 1000 live births. NB by gestational age is classified as PRETERM: NB delivered before 37 completed weeks (<259 days). FULL TERM: NB delivered between 37-42 weeks (260- 294 days). POST TERM: NB delivered after 42 weeks (>295 days). NB gestational age is assessed by: 1. Obstetric information of LMP & EDD 2. Ultrasound examination (very accurate if obtained before 20 weeks' of gestation). 3. Fundal height by obstetrician 4. First reported heart sounds (10-12 weeks by Doppler ultrasound examination) 5. Date of first reported fetal activity (quickening usually occurs at 16-18 weeks) 6. Expanded new Ballard score NB by birth weight on growth charts is classified as: Small for gestational age (SGA) Is NB with birth weight of < 10 th centile 1 Appropriate for age (AGA) Is NB with birth weight between 10th -90th centiles Large for gestational age (LGA) Is NB with birth weight of > 90 th centile Full term neonates normally have the following: BW: Average 3.250 g (7.5 pounds), 95 % (2.500 – 4.250 g) Length: 50 cm, 95 % (46 – 56 cm) OFC 35 cm, 95 % (33 – 38 cm) Hb 14 – 22 g/ dl WBC 5000 - 20000 / cm3 BP 80/50 mm Hg RR 40 – 60 breaths/ minutes PR 120 – 160 beats / minutes Urine passed within 24 hours of birth, max.
    [Show full text]
  • Neonatal Transfusion Shan Yuan M.D
    Neonatal Transfusion Shan Yuan M.D. (Last Updated 4/18/2011) I. Anemia in a neonate: both physiological and iatrogenic (Note: unless otherwise noted, a “neonate” refers to an infant <4mo of age) A. Neonates typically undergo physiologic anemia of infancy due to reduced erythropoietin production, reaching a minimum Hgb of ~9g/dL around 10-12 weeks of age. This decline may occur earlier and faster in premature infants, reaching about 7g/dL or less. B. Anemia of prematurity is further exacerbated by laboratory draws during hospitalization C. In general, the smaller the neonate, the more likely transfusion would be needed. II. Pre-transfusion Testing A. Neonate‟s immune system not fully functional, almost all antibodies are of maternal origin at birth B. Usually a sample is drawn from both mom and infant to check for ABO/Rh type. Reverse type not done on the infant due to lack of endogenous ABO antibody production. C. Maternal serum checked also for unexpected non-ABO antibodies. o If negative: no additional compatibility testing (including crossmatching) is required during that hospital stay as long RBC given is group O negative, or ABO/Rh compatible with both mom and the infant o If positive for non-ABO alloantibodies: Can use maternal serum for subsequent compatibility testing Units negative for the appropriate antigen needs to be selected III. Selection and modification of blood products Age of the RBC Unit: o Ideally RBC units are less than 7-10 days of age(“fresh”) to avoid transfusing high levels of K+ and lactate. o This is less crucial in routine transfusions, but more so in massive transfusions (>15-20ml/kg of body weight) Aliquoting from designated unit o Aliquots of small volume transfusions can be removed from the same designated parent unit over days or weeks to reduce donor exposure over time.
    [Show full text]
  • Case Report of Anemia Following Fetal-Maternal Hemorrhage
    Katherine Newnam, PhD, RN, NNP-BC, CPNP, IBCLE, and ElizabethElizabeth Schierholz, Schierholz MSN,, MSN, NNP NNP ❍ Section ❍ Section Editor Editors Case of the Month Case Report of Anemia Following Fetal– Maternal Hemorrhage 06/14/2019 on flw5LIUrhNOxCqp8mpbW9RiCkSS4ziN2BS2bv+qEqdTyZzFEZZUsunYnemHEjVHIdWP5vIxRER9H3atwQQ0uBQ/yKYf2c17teA9PXFkSpxoy9lYQYJtBYg== by http://journals.lww.com/advancesinneonatalcare from Downloaded Kristi L. Coe, MSN, RNC-NIC, NNP-BC, CNS, CPNP Downloaded ABSTRACT from Background: Any maternal history of blood loss, ABO or Rh incompatibility, and hydrops fetalis often leads to suspicion http://journals.lww.com/advancesinneonatalcare of neonatal anemia postnatally. When maternal history consists only of decreased fetal movement, recognition of neo- natal anemia can be problematic. Clinical Findings: This case was a transported late preterm neonate who presented initially with persistent hypoxia unresponsive to usual respiratory support. On examination, mild paleness was noted. Primary Diagnosis: Anemia caused by fetal–maternal hemorrhage was the ultimate diagnosis confirmed by a Kleihauer- Betke test on maternal serum examining fetal cells. Interventions: Neonatal resuscitation included positive pressure ventilation, oxygen, and intubation. However, oxygen- ation did not improve prompting consultation with the neonatologist. Sedation and a paralytic were given. A chest radio- graph ruled out pneumothoraces and pleural effusions as causative. Initiation of inhaled nitric oxide produced a mild by flw5LIUrhNOxCqp8mpbW9RiCkSS4ziN2BS2bv+qEqdTyZzFEZZUsunYnemHEjVHIdWP5vIxRER9H3atwQQ0uBQ/yKYf2c17teA9PXFkSpxoy9lYQYJtBYg==
    [Show full text]