Features of clinical and laboratory status of children with anemia of prematurity

Objective. To evaluate and compare anthropometric and early postnatal factors, time of anemia manifistation, treatment and peripheral blood erythroid indicators in premature infants depending on gestational age.
Materials and methods. A retrospective cohort study was conducted of 110 premature newborns with early anemia of prematurity. The babies was divided depending on the gestational age at birth into 3 groups: group 1— up to 28 weeks of gestation (n = 16); group 2 — with a gestational age of 28—31 weeks (n = 63); group 3 — with a gestational age of 32—37 weeks (n = 31). We were analyzed anthropometric parameters, the presence of asphyxia at birth, the need for artificial ventilation of the lungs and its duration, treatment with erythropoietin preparations and erythrocyte blood components. We were studied the indicators of erythroid growth in peripheral blood at the time of birth and at the time of manifestation of anemia. Statistical calculations were carried out in the R statistical package, version 4.3.
Results. The results of the study indicate that there are no statistically significant differences in the timing of manifestation of anemia of prematurity in children depending on the gestational age. We was also found a trend to a decrease in the absolute number of red blood cells at birth with a decrease in gestational age. We found absence of trend of hemoglobin concentration and gestational age. Аt the time of manifestation of anemia а trend of lower values of hemoglobin concentration is determined with a decrease in the gestational age of the premature baby.
Conclusion. Blood transfusion therapy in children with a gestational age of less than 28 weeks is a temporary measure to correct anemia. Hemotransfusions does not reduce the severity of this condition compared to children of later gestational age. Also, the established patterns of changes in the number of erythrocytes and hemoglobin concentration in premature infants at birth indicate the predominance of a violation of the proliferative activity of erythroid cells, but not the processes of hemoglobinization. The analysis of the indicators of the relative number of reticulocytes, taking into account the presence of anemia of anemia of prematurity, indicates the lack of adequate regenerative ability of the erythroid sprout of the bone marrow.

1. National, regional, and global estimates of preterm birth in 2020, with trends from 2010 : a systematic analysis / E. O. Ohuma, A. B. Moller, E. Bradley [et al.] // The Lancet. — 2023. — Vol. 402, Iss. 10409. — P. 1261—1271.

2. Long-term neurodevelopmental outcomes after moderate and late preterm birth : a systematic review / L. Fernandez de Gamarra-Oca, N. Ojeda, A. Gomez-Gastiasoro [et al.] // The Journal of Pediatrics. — 2021. — Vol. 237. — DOI: 10.1016/j.jpeds.2021.06.004.

3. A systematic review of severe morbidity in infants born late preterm / M. J. Teune, S. Bakhuizen, C. G. Bannerman [et al.] // American journal of obstetrics and gynecology. — 2011. — Vol. 205, № 4. — DOI: 10.1016/J.AJOG.2011.07.015.

4. Saigal, S. An overview of mortality and sequelae of preterm birth from infancy to adulthood / S. Saigal, L. W. Doyle // The Lancet. — 2008. — Vol. 371, № 9608. — P. 261—269.

5. Global, regional, and national causes of under-5 mortality in 2000-19 : an updated systematic analysis with implications for the Sustainable Development Goals / J. Perin, A. Mulick, D. Yeung [et al.] // The Lancet Child & adolescent health. — 2022. — Vol. 6, № 2. — P. 106—115.

6. Holzapfel, L. F. Red blood cell transfusion thresholds for anemia of prematurity / L. F. Holzapfel, M. A. Rysavy, E. F. Bell // NeoReviews. — 2023. — Vol. 24, № 6. — DOI: 10.1542/NEO.24-6-E370.

7. The premature infants in need of transfusion (pint) study: a randomized, controlled trial of a restrictive (LOW) versus liberal (HIGH) transfusion threshold for extremely low birth weight infants / H. Kirpalani, R. K. Whyte, C. Andersen [et al.] // The Journal of Pediatrics. — 2006. — Vol. 149, № 3. — P. 301—307.

8. Karnati, S. Late preterm infants - Changing trends and continuing challenges / S. Karnati, S. Kollikonda, J. Abu-Shaweesh // International Journal of Pediatrics and Adolescent Medicine. — 2020. — Vol. 7, № 1. — P. 36—44.

9. Late preterm : high risk newborns despite appearances / D. Snyers, C. Lefebvre, R. Viellevoye, V. Rigo // Revue medicale de Liege. — 2020. — Vol. 75, № 2. — P. 105—110.

10. Late preterm: a new high risk group in neonatology / D. Sharma, I. V. Padmavathi, S. A. Tabatabaii, N. Farahbakhsh // The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. — 2021. — Vol. 34, № 16. — P. 2717—2730.

11. Haemoglobin level at birth is associated with short term outcomes and mortality in preterm infants / J. Banerjee, F. K. Asamoah, D. Singhvi [et al.] // BMC Medicine. — 2015. — Vol. 13. — DOI: 10.1186/s12916-014-0247-6.

12. Effects of transfusions in extremely low birth weight infants: a retrospective study / O. A. Valieva, T. P. Strandjord, D. E. Mayock, S. E. Juul // The Journal of pediatrics. — 2009. — Vol. 155, № 3. — P. 331—337.

13. Erythropoietin serum levels, versus anaemia as risk factors for severe retinopathy of prematurity / P. Lundgren, G. Hellgren, A. Pivodic [et al.] // Pediatric research. — 2019. — Vol. 86, № 2. — P. 276—282.

14. Effect of high-dose erythropoietin on blood transfusions in extremely low gestational age neonates: Post Hoc Analysis of a Randomized Clinical Trial / S. E. Juul, P. T. Vu, B. A. Comstock [et al.] // JAMA pediatrics. — 2020. — Vol. 174, № 10. — DOI: 10.1001/jamapediatrics.2020.2271.

15. Effects of liberal vs restrictive transfusion thresholds on survival and neurocognitive outcomes in extremely low-birth-weight infants: the ETTNO randomized clinical trial / A. R. Franz, C. Engel, D. Bassler [et al.] // JAMA. — 2020. — Vol. 324, № 6. — P. 560—570.

16. Risk factors for anemia of prematurity among 30—35-week preterm infants / H. Kitaoka, Y. Shitara, K. Kashima [et al.] // Fukushima journal of medical science. — 2023. — Vol. 69, № 2. — P. 115—123.

17. Evaluation and treatment of anemia in premature infants / E. Hasanbegovic, N. Cengic, S. Hasanbegovic [et al.] // Medical archives (Sarajevo, Bosnia and Herzegovina). — 2016. — Vol. 70, № 6. — P. 408—412.

18. Всемирная организация здравоохранения : [сайт]. — Женева, 2025. — URL: https://www.who.int/ru/news-room/fact-sheets/detail/preterm-birth (дата обращения: 25.01.2025).

19. Федеральные клинические рекомендации по диагностике и лечению ранней анемии недоношенных детей : утв. президентом Нац. об-ва детск. гематологов и онкологов от 6 июня 2014 г. / А. Г. Румянцев, А. А. Масчан ; ФБГУ «ФНКЦ ДГОИ им. Дмитрия Рогачева» Минздрава России ; Нац. об-во детских гематологов и онкологов России. — URL: https://nodgo.org/sites/default/files/ФКР (дата обращения: 13.03.2025).

20. Jonckheere, A. R. A distribution-free k-sample test against ordered alternatives / A. R. Jonckheere // Biometrika. — 1954. — Vol. 41, № 1/2. — P. 133—145.

21. Agresti, A. Categorical data analysis / A. Agresti. — USA : John Wiley & Sons, 2012. — 792 р.

22. Клинико-лабораторные показатели (референтные интервалы) : пособие для врачей / Е. Т. Зубковская, К. У. Вильчук, И. В. Курлович [и др.]. — Минск : БГУФК, 2019. — 127 с.

23. Ранняя анемия недоношенных (клинические рекомендации) / Е. Н. Балашова, Д. Р. Шарафутдинова, М. В. Нароган [и др.] // Неонатология: новости, мнения, обучение. — 2021. — Т. 9, № 3. — С. 47—61.