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Association of low hemoglobin at birth and neurodevelopmental outcomes in preterm neonates ≤28 weeks’ gestation: a retrospective cohort study

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To compare neurodevelopmental outcomes at 18–24 months corrected age (CA) for preterm infants who had hemoglobin levels <120 g/l versus those with hemoglobin level ≥120 g/l at birth.

Methods

We included infants of ≤28 weeks gestational age (GA) born between January 2009 and June 2018. The primary outcome was neurodevelopmental impairment (NDI) at 18–24 months. Multivariable logistic regression was applied to determine the association.

Results

Of the 2351 eligible neonates, 351 (14.9%) had hemoglobin levels <120 g/L at birth. Of the 2113 surviving infants, 1534 (72.5%) underwent developmental follow-up at 18–24 months CA. There was no statistically significant difference in ND outcomes between the two groups. The composite outcome of death or NDI was significantly higher in the low hemoglobin group.

Conclusion

In preterm infants ≤28 weeks GA, initial hemoglobin <120 g/L at birth was not associated with neurodevelopmental impairment at 18–24 months CA among survivors.

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Data availability

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

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Acknowledgements

We would like to thank Mr. “Junmin Yang”, our dedicated statistician, for his contributions to the data analysis in this study. Our appreciation also goes to Mr. Sonny Yeh for generously providing us with the essential data sourced from the CNN database. Additionally, we would like to express our heartfelt thanks to the families and diligent nurses at Mount Sinai Hospital and Sunnybrook Hospital. We are also indebted to the CNN and CNN-FUN personnel whose assistance was instrumental in the successful completion of our study.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada

    Mohamed Elkhouli, Kamini Raghuram, Thanna Elhanafy, Elizabeth Asztalos, Rudaina Banihani, Prakesh S. Shah & Adel Mohamed

  2. Department of Pediatrics, Scarborough Health Network, Toronto, Ontario, Canada

    Mohamed Elkhouli

  3. Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada

    Kamini Raghuram, Thanna Elhanafy, Prakesh S. Shah & Adel Mohamed

  4. DAN Women & Babies Program, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada

    Elizabeth Asztalos & Rudaina Banihani

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  1. Mohamed Elkhouli
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Contributions

ME had the main contribution to the study design, data collection, and manuscript writing. AM had full access to all of the data and takes responsibility for the content of this manuscript, including study design, data, and data analysis. The study design was conducted by ME and AM, data collection was performed by ME and TE. The manuscript was prepared by ME and KR and then edited by KR, PS, EA, RB, and AM. All authors of this study approved the final draft of the manuscript. AM assumes full responsibility for the manuscript’s content, encompassing both the data and analysis.

Corresponding author

Correspondence to Adel Mohamed.

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Competing interests

The authors declare no competing interests.

Ethics approval

Local research ethics approval was obtained (Mount Sinai Hospital REB #21-0194-C & Sunnybrook Hospital 5132), Toronto, ON, Canada. Consent to participate Written informed consent from parents or guardians was waivered. Consent for publication All the authors have seen the final version of the manuscript and gave their full consent for the publication. We acknowledge the study was performed in accordance with the Declaration of Helsinki.

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Elkhouli, M., Raghuram, K., Elhanafy, T. et al. Association of low hemoglobin at birth and neurodevelopmental outcomes in preterm neonates ≤28 weeks’ gestation: a retrospective cohort study. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01946-y

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  • DOI: https://doi.org/10.1038/s41372-024-01946-y

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