title: Effect of neonatal hemoglobin concentration on long-term outcome of infants affected by fetomaternal hemorrhage.
abstract: BACKGROUND
  Fetomaternal hemorrhage (FMH) can cause severe morbidity. However, perinatal risk factors for long-term poor outcome due to FMH have not been extensively studied.
  
  
  OBJECTIVE
  To determine which FMH infants are likely to have neurological sequelae.
  
  
  METHODS
  A single-center retrospective observational study. Perinatal factors, including demographic characteristics, Kleihauer-Betke test, blood gas analysis, and neonatal blood hemoglobin concentration ([Hb]), were analyzed in association with long-term outcomes.
  
  
  METHODS
  All 18 neonates referred to a Neonatal Intensive Care Unit of Kagoshima City Hospital and diagnosed with FMH during a 15-year study period. All had a neonatal [Hb] <7.5g/dL and 15 of 17 neonates tested had Kleihauer-Betke test result >4.0%.
  
  
  METHODS
  Poor long-term outcome was defined as any of the following determined at 12 month old or more: cerebral palsy, mental retardation, attention deficit/hyperactivity disorder, and epilepsy.
  
  
  RESULTS
  Nine of the 18 neonates exhibited poor outcomes. Among demographic characteristics and blood variables compared between two groups with poor and favorable outcomes, significant differences were observed in [Hb] (3.6±1.4 vs. 5.4±1.1g/dL, P=0.01), pH (7.09±0.11 vs. 7.25±0.13, P=0.02) and base deficits (17.5±5.4 vs. 10.4±6.0mmol/L, P=0.02) in neonatal blood, and a number of infants with [Hb]≤4.5g/dL (78%[7/9] vs. 22%[2/9], P=0.03), respectively. The base deficit in neonatal arterial blood increased significantly with decreasing neonatal [Hb].
  
  
  CONCLUSIONS
  Severe anemia causing severe base deficit is associated with neurological sequelae in FMH infants.
authors: Division of Neonatology, Perinatal Medical center, Kagoshima City Hospital, Kagoshima, Japan. Electronic address: mizuho0@hotmail.com.
authors: Mizuho
authors: M
authors: Kadooka
authors: Division of Anesthesiology, Nanpuh Hospital, Kagoshima City, Kagoshima, Japan.
authors: Hiromi
authors: H
authors: Kato
authors: Perinatal Center, Imakiire General Hospital, Division of Neonatology, Kagoshima, Kagoshima, Japan.
authors: Akihiko
authors: A
authors: Kato
authors: Division of Neonatology, Perinatal Medical center, Kagoshima City Hospital, Kagoshima, Japan.
authors: Satoshi
authors: S
authors: Ibara
authors: Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Hisanori
authors: H
authors: Minakami
authors: Perinatal Center, Imakiire General Hospital, Division of Neonatology, Kagoshima, Kagoshima, Japan.
authors: Yuko
authors: Y
authors: Maruyama
mesh_terms: D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D008431:Maternal-Fetal Exchange; D011247:Pregnancy
chemical_list: D006454:Hemoglobins
keywords: Fetal growth restriction; Fetal heart rate pattern; Fetomaternal transfusion; Long-term outcome; Neurological development; Sinusoidal pattern