Anemia of Prematurity - Portal Neonatal

IVT in 1981. With ultrasonographic guidance, a needle is introduced into an umbilical vessel, and a
fetal blood sample is obtained. The blood sample is confirmed to be of fetal origin by rapid alkaline
denaturation test. All the relevant fetal tests (eg, Hb, Hct, blood type, DAT, reticulocyte count, platelet
count, serum albumin, erythropoietin level) are sent. If the Hb is below 11 g/dL, an IVT is started. The
position of the needle is confirmed by noting the turbulence in the fetal vessel on injection of saline.
The fetus is frequently paralyzed with pancuronium in order to prevent the displacement of the needle
by fetal movements.
The transfusion is performed in 10-mL aliquots to a volume of 50 mL/kg estimated body weight or until
Hct of 60% is reached. The procedure is discontinued promptly if cardiac decompensation is noted on
ultrasonography. In addition to all the complications of IPT, umbilical vein compression has also been
noted during IVT. However, IVT has many advantages, such as immediate correction of anemia and
resolution of fetal hydrops, reduced rate of hemolysis and subsequent hyperinsulinemia, and
acceleration of fetal growth for nonhydropic fetuses who often are growth retarded. IVT also is the only
intervention available for moribund hydropic fetuses and those with anterior placenta. The risk of fetal
loss is about 0.8% with IVT versus 3.5% per procedure for IPT, and the overall survival rate is 88%.
Management of the sensitized neonate
Mild hemolytic disease accounts for 50% of newborns with positive DAT results. Most of these
newborns have no anemia (cord Hb >14 g/dL) and minimal hemolysis (cord bilirubin