Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT; Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
J Pediatr. 2022 Sep;248:39-45.e2. doi: 10.1016/j.jpeds.2022.05.045. Epub 2022 Jun 1.
To identify neonates with severe anemia at birth, defined by a hemoglobin or hematocrit value within the first 6 hours after birth that plotted below the 1st percentile according to gestational age. For each patient, we retrospectively determined whether caregivers recognized the anemia within the first 24 hours after birth and the probable cause and outcome of anemia.
This was a retrospective cohort analysis of Intermountain Healthcare population-based data from neonates born between January 2011 and December 2020 who had a hemoglobin or hematocrit value measured within the first 6 hours after birth below the 1st percentile lower reference interval (hematocrit ∼35% in near-term/term neonates).
Among 299 927 live births, we identified 344 neonates with severe anemia at birth. In 191 of these neonates (55.5%), the anemia was recognized by caregivers during the first 24 hours. Anemia was more likely to be recorded as a problem (85%) if the hemoglobin was ≥2 g/dL below the 1st percentile (P < .001). The lowest hemoglobin values occurred in those in whom hemorrhage was the probable cause (P < .013 vs hemolysis and P < .001 vs hypoproduction, mixed cause, or indeterminant.) Treatment was provided to 39.5%. A retrospective review suggested that mixed mechanisms, particularly hemorrhagic plus hemolytic, occurred more commonly than was recognized at the time of occurrence.
Severe anemia at birth often went unrecognized on the first day of life. Algorithm-directed retrospective reviews commonly identified causes that were not listed in the medical record. We postulate that earlier recognition and more accurate diagnoses would be facilitated by an electronic medical record-associated hemoglobin/hematocrit gestational age nomogram.
确定出生时患有严重贫血的新生儿，其定义为出生后 6 小时内的血红蛋白或血细胞比容值低于根据胎龄绘制的第 1 百分位。对于每个患者，我们回顾性地确定了在出生后 24 小时内护理人员是否识别出贫血，以及贫血的可能原因和结果。
这是对 2011 年 1 月至 2020 年 12 月期间出生的、出生后 6 小时内血红蛋白或血细胞比容值低于第 1 百分位下限参考区间（足月/近足月新生儿血细胞比容约为 35%）的 Intermountain Healthcare 人群数据进行的回顾性队列分析。
在 299927 例活产儿中，我们确定了 344 例出生时患有严重贫血的新生儿。在这些新生儿中，有 191 例（55.5%）在出生后 24 小时内被护理人员识别出贫血。如果血红蛋白值比第 1 百分位低 2g/dL 以上（P<.001），则更有可能记录为问题。最低的血红蛋白值出现在出血是可能原因的新生儿中（与溶血相比，P<.013；与低产生、混合原因或不确定相比，P<.001）。给予了 39.5%的治疗。回顾性复查表明，混合机制，特别是出血性加溶血性，比当时发生时更常见。
出生时的严重贫血在生命的第一天经常未被识别。基于算法的回顾性审查通常会发现病历中未列出的原因。我们推测，通过电子病历相关的血红蛋白/血细胞比容胎龄图表，可以更早地识别并做出更准确的诊断。
