Anemia of Prematurity - Portal Neonatal

Causes:
umbilical artery, gastrointestinal atresias, and a narrow chest secondary to external
compression. Infants are typically small for their stated gestational age (SGA). When an
abdominal mass is found on examination of the infant in this clinical setting, it often
represents multicystic-dysplastic kidney, enlarged urinary bladder, or prune-belly
syndrome.
• Polyhydramnios
o Twin gestation with twin-to-twin transfusion (increased amniotic fluid in the recipient twin
and decreased amniotic fluid in the donor) or multiple gestations, which can lead to twinto-twin
transfusion syndrome
o Fetal anomalies, including esophageal atresia (usually associated with a
tracheoesophageal fistula), tracheal agenesis, duodenal atresia, and other intestinal
atresias
o CNS abnormalities and neuromuscular diseases that cause swallowing dysfunction
o Congenital cardiac-rhythm anomalies associated with hydrops, fetal-to-maternal
hemorrhage, and parvovirus infection
o Maternal type 2 diabetes mellitus (more often than in oligohydramnios)
o Chromosomal abnormalities, most commonly trisomy 21, followed by trisomy 18 and
trisomy 13.
o Fetal akinesia syndrome with absence of swallowing
• Oligohydramnios
o Fetal urinary tract anomalies, such as renal agenesis, polycystic kidneys, or any urinary
obstructive lesion (eg, posterior urethral valves)
o Maternal problems, including placental insufficiency, PROM, and chronic leakage of the
amniotic fluid: The major maternal complication from oligohydramnios is
chorioamnionitis, which has an incidence of 21-74%. The earlier chorioamnionitis occurs
in pregnancy, the greater the fetal risk of bronchopulmonary dysplasia (BPD); neurologic
complications; pulmonary hypoplasia; and, in severe cases, respiratory failure.
o Maternal use of prostaglandin synthase inhibitors or angiotensin-converting enzyme
(ACE) inhibitors
o Postmaturity syndrome in infants when a pregnancy extends beyond 42 weeks'
gestation (possibly caused by a decline in placental function)
WORKUP Section 4 of 9
Lab Studies:
• Lecithin-sphingomyelin (L:S) ratio and phosphatidylglycerol (PG) levels in the amniotic fluid:
If premature delivery is anticipated with either oligohydramnios or polyhydramnios, the
amniotic fluid L:S ratio and PG concentration are helpful in determining the maturity of the
fetal lungs and, therefore, in assessing the likelihood of respiratory distress syndrome.
• Polyhydramnios
o Glucose tolerance test for mothers with suspected type 2 diabetes mellitus
o If associated fetal hydrops is present, screening for maternal antibodies to D, C, Kell,
Duffy, and Kidd antigens to determine the mother's immunity
o Kleihauer-Betke test to evaluate fetal-maternal hemorrhage
o Venereal Disease Research Laboratories (VDRL) test to screen for syphilis
o Immunoglobulin G (IgG) and immunoglobulin M (IgM) titers to evaluate for exposure to
rubella, cytomegalovirus (CMV), and toxoplasmosis
o Hemoglobin Bart in patients of Asian descent (heterozygous for alpha-thalassemia)