Anemia of Prematurity - Portal Neonatal

TREATMENT Section 6 of 10
Medical Care: The medical care options available to the clinician treating an infant with AOP are
prevention, blood transfusion, and recombinant EPO treatment.
Prevention
• Reducing the amount of blood taken from the premature infant diminishes the need to replace
blood. When caring for the premature infant, carefully consider the need for each laboratory
study obtained. Hospitals with care for premature infants should have the ability to determine
laboratory values using very small volumes of serum.
• Manufacturers are developing an array of technologies that require extremely small amounts
of blood for a steadily increasing number of tests. Likewise, devices that allow blood gases
and serum chemistries to be determined at bedside via an analyzer attached to the umbilical
artery catheter without loss of blood recently have been developed. The impact of such
devices on the development of anemia and/or the need for transfusions has yet to be
determined.
• The use of noninvasive monitoring devices, such as transcutaneous hemoglobin oxygen
saturation, partial pressure of oxygen, and partial pressure of carbon dioxide, may allow
clinicians to decrease blood drawing; however, no data currently support such an impact of
these devices.
Blood transfusion
• Packed red blood cell (PRBC) transfusions: Despite disagreement regarding timing and
efficacy, PRBC transfusions continue to be the mainstay of therapy for the individual with
AOP. The frequency of blood transfusions varies with gestational age, degree of illness, and,
interestingly, the hospital evaluated.
• Reducing the number of transfusions: Studies derived from individual centers document a
marked decrease in the administration of PRBC transfusions over the past 2 decades, even
before the use of EPO. This decrease in transfusions is almost certainly multifactorial in origin.
One frequently mentioned component is the adoption of transfusion protocols that take a
variety of factors into account, including hemoglobin levels, degree of cardiorespiratory
disease, and traditional signs and symptoms of pathologic anemia. Using various audit criteria
and indications for transfusions suggested by Canadian, American, and British authorities, the
Medical University of South Carolina has instituted the following transfusion guidelines:
o Do not transfuse for phlebotomy losses alone.
o Do not transfuse for hematocrit alone, unless the hematocrit level is less than 21% with a
reticulocyte count less than 100,000.
o Transfuse for shock associated with acute blood loss.
o For an infant with cyanotic heart disease, maintain a hemoglobin level that provides an
equivalent fully saturated level of 11-12 g.
o Transfuse for hematocrit levels less than 35-40% in the following situations:
� Infant with severe pulmonary disease (defined as requiring >35% supplemental
hood oxygen or continuous positive airway pressure [CPAP] or mechanical
ventilation with a mean airway pressure of >6 cm water)
� Infant in whom anemia may be contributing to congestive heart failure
o In the following situations, transfuse for a hematocrit level that is 25-30% or less:
� The patient requires nasal CPAP of 6 cm water or less (supplemental hood oxygen of
9 episodes in 12 h or
2 episodes in 24 h, requiring bag-mask ventilation while receiving therapeutic doses of
methylxanthines).
� The patient has persistent tachycardia or tachypnea without other explanation for 24h.
� Weight gain of patient is deemed unacceptable in light of adequate caloric intake
without other explanation, such as known increases in metabolic demands or known
losses in metabolic demands (malabsorption).
� The patient is scheduled for surgery; transfuse in consultation with the surgery team.