Anemia of Prematurity - Portal Neonatal

• The use of other pharmacological modalities to prevent PVH-IVH has been proposed;
however, this use is not widely accepted. The other pharmacological modalities include
prenatal treatment with vitamin K and phenobarbital and postnatal treatment with
Ethamsylate, phenobarbital, and vitamin E. Although positive reports concerning the efficacy
of these agents exist, further investigation is required to prove conclusive evidence of benefit.
Complications:
• Obstructive hydrocephalus
• Nonobstructive hydrocephalus
• Developmental impairment
• Cerebral palsy
• Seizures
Prognosis:
• Grade I and grade II hemorrhage: Neurodevelopmental prognosis is excellent (ie, perhaps
slightly worse than infants of similar gestational ages without PVH-IVH).
• Grade III hemorrhage without white matter disease: Mortality is less than 10%. Of these
patients, 30-40% have subsequent cognitive or motor disorders.
• Grade IV (severe PVH-IVH) IVH with either periventricular hemorrhagic infarction and/or
periventricular leukomalacia: Mortality approaches 80%. A 90% incidence of severe
neurological sequelae including cognitive and motor disturbances exists.
Patient Education:
• Prenatal
o Specific risks of gestational age
o Sequelae
• Postnatal
o Provide postnatal education (if not provided previously) or reinforce prenatal education.
o Provide results of sonography and expectations for short-term and long-term care.
MISCELLANEOUS Section 9 of 11
Medical/Legal Pitfalls: Use of indomethacin
o According to randomized controlled trials, the use of indomethacin appears to be effective
in the prevention of PVH-IVH. However, this therapy is not accepted universally because
of potential complications of treatment. Whether or not failure to use indomethacin (or the
use of the drug with subsequent complications) could result in civil liability is not clear.
o Additionally, in order to be effective, indomethacin must be administered within hours of
birth. The number of at-risk premature patients who could conceivably receive the drug is
large. Obtaining a pre-indomethacin echocardiogram to rule out an underlying cardiac
condition in which patency of the ductus arteriosus is essential may be considered
impractical and not cost effective. Whether or not legal risk is associated with the failure to
diagnose a ductal-dependent lesion prior to administering indomethacin is not clear.
Special Concerns: In patients with posthemorrhagic ventricular dilation that regresses, provide close
follow-up care because hydrocephalus can recur.