Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
Obstetric and Neonatal Operations, Intermountain Health, Murray, UT.
Neoreviews. 2023 Jun 1;24(6):e343-e355. doi: 10.1542/neo.24-6-e343.
It is important for clinicians who render neonatal care to precisely and reproducibly diagnose anemia; however, confusion arises from various definitions. For the simplicity and consistency of detection, we advocate defining neonatal anemia as a hemoglobin level or hematocrit below the 5th percentile of the reference population, which is highly dependent on gestational and postnatal ages. Thus, a newborn infant delivered at 24 weeks' gestation will have anemia with a blood hemoglobin concentration much lower than a hemoglobin concentration defining anemia at term. Moreover, a hemoglobin concentration defining anemia at term birth is higher than that defining anemia in the same infant 60 days after birth. Diagnosing neonatal anemia can be evidence-based and consistent by using reference intervals derived from large neonatal databases. To do this, we advocate defining anemia as a hemoglobin level that plots below the 5th percentile lower reference interval, defining moderately severe anemia as a hemoglobin value between the 1st and 5th percentile, and defining severe anemia as a hemoglobin level that plots below the 1st percentile. The information provided in this review can easily be adopted by clinical laboratories and individual neonatal care units, thereby fostering application of these definitions for all infants whose hemoglobin levels are measured. Additional normative values included in this review describing various other erythrocyte metrics can likewise be easily adopted. Doing so will codify and standardize the diagnosis of neonatal anemia and will facilitate identifying the cause of the anemia, thus pointing the way to proper additional diagnostic testing and treatment.
对于提供新生儿护理的临床医生来说，准确且可重复地诊断贫血至关重要；然而，各种定义却造成了混淆。为了检测的简单性和一致性，我们主张将新生儿贫血定义为血红蛋白水平或血细胞比容低于参考人群第 5 个百分位数，这高度依赖于胎龄和出生后年龄。因此，胎龄为 24 周的新生儿出生时的血红蛋白浓度会远低于足月时定义贫血的血红蛋白浓度。此外，足月出生时定义贫血的血红蛋白浓度高于出生后 60 天时定义同一婴儿贫血的血红蛋白浓度。通过使用来自大型新生儿数据库的参考区间，可以基于证据且一致地诊断新生儿贫血。为此，我们主张将血红蛋白水平低于第 5 个百分位的参考区间定义为贫血，将血红蛋白值在第 1 个和第 5 个百分位之间定义为中度严重贫血，将血红蛋白水平低于第 1 个百分位定义为严重贫血。本综述中提供的信息可以很容易地被临床实验室和单个新生儿护理单位采用，从而促进对所有测量血红蛋白水平的婴儿应用这些定义。本综述中描述的其他各种红细胞指标的额外正常值也可以很容易地被采用。这样做将规范和标准化新生儿贫血的诊断，并有助于确定贫血的原因，从而为进一步的适当诊断测试和治疗指明方向。
