Morbidity Associated with Early Neonatal Anemia in Preterm and Term Infants: An Observational Study with Propensity Score Matching

Introduction: Anemia in preterm infants is associated with neonatal morbidity outcomes, such as intraventricular hemorrhage (IVH), necrotizing enterocolitis, and bronchopulmonary dysplasia. This study aimed to describe the prevalence of early neonatal anemia (ENA) and evaluate the morbidity and mortality in preterm and term infant. Methods: We conducted a single-center case-control study among a cohort of 1,603 inborn infants admitted in our neonatal medicine department between June 2017 and April 2021. We included 115 infants with ENA defined as first hemoglobin level <14 g/dL. A control group of 115 infants were matched using a propensity score. Results: The median hemoglobin at admission value was of 12.3 g/dL for cases and 17.3 g/dL for controls. Cases with ENA needed more cardiopulmonary resuscitation in the delivery room (OR 4.7; 95% CI: 2.1–12.3) and mechanical ventilation (OR 2.4; 95% CI: 1.4–4.2). ENA was significantly associated with circulatory failure requiring aminergic support (OR 3.2; 95% CI: 1.5–7), transfusion (OR 11; 95% CI: 4.4–32.6), and volume expansion (OR 4.7; 95% CI: 2.2–11). Hemodynamically significant patent ductus arteriosus and IVH (OR 3; 95% CI: 1.5–6.3) are significantly increased in the anemia group. Conclusion: ENA is significantly associated with severe hemodynamics, respiratory and neurological morbidities. These complications seem to occur during the adaptation to the extrauterine life. Early peripartum detection of anemia should be investigated in further studies.