Anemia of Prematurity - Portal Neonatal

• Magnesium concentration (serum)
o Hypomagnesemia is related to younger maternal age, severity of maternal diabetes, and
prematurity. Neonatal magnesium levels are also related to maternal serum magnesium,
neonatal calcium and phosphorus levels, and neonatal parathyroid function.
o The clinical significance of low magnesium levels in these infants remains controversial
and uncertain.
• Calcium concentration (serum, ionized or total levels): Low serum calcium levels in IDMs are
common. They are speculated to be caused by a functional hypoparathyroidism; however,
their clinical relevance remains uncertain and controversial.
• Bilirubin level (serum, total and unconjugated): Hyperbilirubinemia is notably more common
than in the general population of neonates. Causative factors include prematurity, hepatic
enzyme immaturity, polycythemia with hyperviscosity and "sludging," and reduced red blood
cell half-life.
• Arterial blood gas: Assessing oxygenation and ventilation is essential in infants with clinical
evidence of respiratory distress. Although noninvasive methods (eg, transcutaneous oxygen
and carbon dioxide electrodes, oximeters) have gained wide acceptance at many centers,
comparison of results with those from arterial blood is intermittently required.
Imaging Studies:
• Chest radiograph
o Clinical evidences of cardiopulmonary distress require a detailed evaluation, which always
should include a chest radiograph.
o Adequacy of lung expansion, evidences of focal or diffuse atelectasis, presence of
interstitial fluid, signs of free air in pleural or interstitial spaces, as well as findings of
pneumonia should be looked for carefully. The possibility of pulmonary malformations also
should be considered. In the macrosomic infant with a history of shoulder dystocia,
examination of the clavicles may be indicated.
o Cardiac size, shape, and great vessel/outflow tract should be examined carefully.
• Cardiac echocardiogram
o A thickened myocardium and significant septal hypertrophy may be present in as many as
1 in 3 IDMs. Evidence of hypercontractile, thickened myocardium, often with septal
hypertrophy disproportionate to the size of the ventricular free walls, may be noted on
examination. Myocardial contractility also should be evaluated because the myocardium is
overstretched and poorly contractile with congenital cardiomyopathies. Evidence of
anatomical malformation must be searched for carefully because cardiac malformations
are significantly more common in IDMs, including a VSD and a TGA.
• Abdominal, pelvic, or lower extremity radiographs
o When caudal dysplasia is present, anatomic details must be evaluated. Orthopedic
anomalies may include fusion of the legs, hypoplastic femur, defects of the tibia and the
fibula,flexion contractures of the knee and hip,or clubfoot.Sacral agenesis also is describe
o Lower extremity congenital malformations require radiographic evaluation to determine the
exact skeletal defect or defects present.
• Barium enema
o Infants with feeding intolerance, abdominal distention, nonbilious emesis, or poor passage
of meconium may require a barium enema. Congenital anomalies of the gastrointestinal
tract are more common in IDMs. These infants may have "small left colon syndrome," also
known as "lazy colon."