title: Haemoglobin level at birth is associated with short term outcomes and mortality in preterm infants.
abstract: BACKGROUND
  Blood volume and haemoglobin (Hb) levels are increased by delayed umbilical cord clamping, which has been reported to improve clinical outcomes of preterm infants. The objective was to determine whether Hb level at birth was associated with short term outcomes in preterm infants born at ≤32 weeks gestation.
  
  
  METHODS
  Data were collected retrospectively from electronic records: Standardised Electronic Neonatal Database, Electronic Patient Record, Pathology (WinPath), and Blood Bank Electronic Database. The study was conducted in a tertiary perinatal centre with around 5,500 deliveries and a neonatal unit admission of 750 infants per year. All inborn preterm infants of 23 to 32 weeks gestational age (GA) admitted to the neonatal unit from January 2006 to September 2012 were included. The primary outcomes were intra-ventricular haemorrhage, necrotising entero-colitis, broncho-pulmonary dysplasia, retinopathy of prematurity, and death before discharge. The secondary outcomes were receiving blood transfusion and length of intensive care and neonatal unit days. The association between Hb level (g/dL) at birth and outcomes was analysed by multiple logistic regression adjusting for GA and birth weight (BWt).
  
  
  RESULTS
  Overall, 920 infants were eligible; 28 were excluded because of missing data and 2 for lethal congenital malformation. The mean (SD) GA was 28.3 (2.7) weeks, BWt was 1,140 (414) g, and Hb level at birth was 15.8 (2.6) g/dL.Hb level at birth was significantly associated with all primary outcomes studied (P <0.001) in univariate analyses. Once GA and BWt were adjusted for, only death before discharge remained statistically significant; the OR of death for infants with Hb level at birth <12 g/dL compared with those with Hb level at birth of ≥18 g/dL was 4.1 (95% CI, 1.4-11.6). Hb level at birth was also significantly associated with blood transfusion received (P <0.01) but not with duration of intensive care or neonatal unit days.
  
  
  CONCLUSIONS
  Low Hb level at birth was significantly associated with mortality and receiving blood transfusion in preterm infants born at ≤32 weeks gestation. Further studies are needed to determine the association between Hb level at birth and long-term neurodevelopmental outcomes.
authors.forename: Jayanta
authors.initials: J
authors.lastname: Banerjee
authors.forename: Felix K
authors.initials: FK
authors.lastname: Asamoah
authors.forename: Devpriya
authors.initials: D
authors.lastname: Singhvi
authors.forename: Angela W G
authors.initials: AW
authors.lastname: Kwan
authors.forename: Joan K
authors.initials: JK
authors.lastname: Morris
authors.affiliation: Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton, London E9 6SR, UK. narendra.aladangady@homerton.nhs.uk.
authors.forename: Narendra
authors.initials: N
authors.lastname: Aladangady
mesh_terms: D000704:Analysis of Variance; D001724:Birth Weight; D001803:Blood Transfusion / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D054238:Perinatal Mortality; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins