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Am J Perinatol 2021; 38(06): 553-559
DOI: 10.1055/s-0039-1700488
Original Article

Anemia of Prematurity and Oral Feeding Milestones in Premature Infants

Sreekanth Viswanathan
1   Division of Neonatology, Department of Pediatrics, Nemours Children’s Hospital, University of Central Florida College of Medicine, Orlando, Florida
2   Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
,
Sudarshan Jadcherla
2   Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
3   Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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Abstract

Objective Anemia of prematurity (AOP) and oral feeding problems are common in premature infants. This study aimed to determine the influence of AOP on aerodigestive outcomes and the duration to full Per Oral (PO).

Study Design Prospectively collected data on premature infants who initiated oral feeds at ≤ 34 weeks' postmenstrual age were examined. Infants were categorized into “AOP+” and “AOP−” based on hematocrit at initial PO, that is, < 29 or ≥ 29%.

Results Forty-four infants in AOP+ compared with 74 in AOP−. AOP+ infants had lower birth gestation and weight (p < 0.001). The anthropometrics at initial PO were similar. AOP+ had lower mean hematocrit and higher oxygen need at initial PO, and at full PO (p < 0.05). AOP+ reached full PO at a later gestation and took longer days from initial PO to full PO (p < 0.01). BPD, intraventricular hemorrhage (IVH ≤ 2), and hospital stay were greater in the AOP+ (p < 0.05). After adjusting for covariates, initial PO hematocrit was not predictive of time to full PO [hazard ratio 1.3 (CI 0.88–2.0), p = 0.18].

Conclusion AOP is not independently associated with the duration to full PO. Supplemental oxygen for associated comorbidities may have compensated for the underlying anemia.

Keywords

anemia of prematurity - oral feeding - premature infants


Publication History

Received: 07 June 2019

Accepted: 09 September 2019

Article published online:
27 November 2019

© 2019. Thieme. All rights reserved.

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  • References

  • 1 American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008; 122 (05) 1119-1126
    CrossrefPubMedGoogle Scholar
  • 2 Horton J, Atwood C, Gnagi S, Teufel R, Clemmens C. Temporal trends of pediatric dysphagia in hospitalized patients. Dysphagia 2018; 33 (05) 655-661
    CrossrefPubMedGoogle Scholar
  • 3 Jadcherla SR, Wang M, Vijayapal AS, Leuthner SR. Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study. J Perinatol 2010; 30 (03) 201-208
    CrossrefPubMedGoogle Scholar
  • 4 Sanchez K, Morgan AT, Slattery JM. et al. Neuropredictors of oromotor feeding impairment in 12-month-old children. Early Hum Dev 2017; 111: 49-55
    CrossrefPubMedGoogle Scholar
  • 5 Jadcherla S. Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr 2016; 103 (02) 622S-628S
    CrossrefPubMedGoogle Scholar
  • 6 Giannì ML, Sannino P, Bezze E. et al. Effect of co-morbidities on the development of oral feeding ability in pre-term infants: a retrospective study. Sci Rep 2015; 5: 16603
    CrossrefPubMedGoogle Scholar
  • 7 Walsh MC, Bell EF, Kandefer S. et al. Neonatal outcomes of moderately preterm infants compared to extremely preterm infants. Pediatr Res 2017; 82 (02) 297-304
    CrossrefPubMedGoogle Scholar
  • 8 Jadcherla SR, Khot T, Moore R, Malkar M, Gulati IK, Slaughter JL. Feeding methods at discharge predict long-term feeding and neurodevelopmental outcomes in preterm infants referred for gastrostomy evaluation. J Pediatr 2017; 181: 125-130.e1
    CrossrefPubMedGoogle Scholar
  • 9 Lainwala S, Kosyakova N, Power K. et al. Delayed achievement of oral feedings is associated with adverse neurodevelopmental outcomes at 18 to 26 months follow-up in preterm infants. Am J Perinatol 2019; DOI: 10.1055/s-0039-1681059.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Christensen RD, Ohls RK. Anemia in the neonatal period. In: Buonocore G, Bracci R, Weindling M. , eds. Neonatology. Switzerland: Springer, Cham; 2018
    CrossrefGoogle Scholar
  • 11 Bromiker R, Kasinetz Y, Kaplan M, Hammerman C, Schimmel M, Medoff-Cooper B. Sucking improvement following blood transfusion for anemia of prematurity. Arch Pediatr Adolesc Med 2012; 166 (10) 897-901
    CrossrefPubMedGoogle Scholar
  • 12 Whitehead HV, Vesoulis ZA, Maheshwari A, Rao R, Mathur AM. Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised?. J Perinatol 2018; 38 (08) 1022-1029
    CrossrefPubMedGoogle Scholar
  • 13 Mintzer JP, Parvez B, La Gamma EF. Regional tissue oxygen extraction and severity of anemia in very low birth weight neonates: a pilot NIRS analysis. Am J Perinatol 2018; 35 (14) 1411-1418
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 van Hoften JC, Verhagen EA, Keating P, ter Horst HJ, Bos AF. Cerebral tissue oxygen saturation and extraction in preterm infants before and after blood transfusion. Arch Dis Child Fetal Neonatal Ed 2010; 95 (05) F352-F358
    CrossrefPubMedGoogle Scholar
  • 15 Henry E, Christensen RD, Sheffield MJ. et al. Why do four NICUs using identical RBC transfusion guidelines have different gestational age-adjusted RBC transfusion rates?. J Perinatol 2015; 35 (02) 132-136
    CrossrefPubMedGoogle Scholar
  • 16 Jadcherla SR, Dail J, Malkar MB, McClead R, Kelleher K, Nelin L. Impact of process optimization and quality improvement measures on neonatal feeding outcomes at an all-referral neonatal intensive care unit. J Parenter Enteral Nutr 2016; 40 (05) 646-655
    CrossrefPubMedGoogle Scholar
  • 17 Lau C, Alagugurusamy R, Schanler RJ, Smith EO, Shulman RJ. Characterization of the developmental stages of sucking in preterm infants during bottle feeding. Acta Paediatr 2000; 89 (07) 846-852
    CrossrefPubMedGoogle Scholar
  • 18 Jadcherla SR, Peng J, Moore R. et al. Impact of personalized feeding program in 100 NICU infants: pathophysiology-based approach for better outcomes. J Pediatr Gastroenterol Nutr 2012; 54 (01) 62-70
    CrossrefPubMedGoogle Scholar
  • 19 Alkalay AL, Galvis S, Ferry DA, Simmons CF, Krueger Jr RC. Hemodynamic changes in anemic premature infants: are we allowing the hematocrits to fall too low?. Pediatrics 2003; 112 (04) 838-845
    CrossrefPubMedGoogle Scholar
  • 20 Roberson RS, Bennett-Guerrero E. Impact of red blood cell transfusion on global and regional measures of oxygenation. Mt Sinai J Med 2012; 79 (01) 66-74
    CrossrefPubMedGoogle Scholar
  • 21 Cesari M, Penninx BW, Lauretani F. et al. Hemoglobin levels and skeletal muscle: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2004; 59 (03) 249-254
    CrossrefPubMedGoogle Scholar
  • 22 Stugiewicz M, Tkaczyszyn M, Kasztura M, Banasiak W, Ponikowski P, Jankowska EA. The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications. Eur J Heart Fail 2016; 18 (07) 762-773
    CrossrefPubMedGoogle Scholar
  • 23 Aktas S, Ergenekon E, Ozcan E. et al. Effects of blood transfusion on regional tissue oxygenation in preterm newborns are dependent on the degree of anaemia. J Paediatr Child Health 2019; DOI: 10.1111/jpc.14378.
    CrossrefPubMedGoogle Scholar
  • 24 Ozcan B, Aydemir O, Isik DU, Bas AY, Demirel N. Severe anemia is associated with intestinal injury in preterm neonates. Am J Perinatol 2019; DOI: 10.1055/s-0039-1683982.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Arthur CM, Nalbant D, Feldman HA. et al. Anemia induces gut inflammation and injury in an animal model of preterm infants. Transfusion 2019; 59 (04) 1233-1245
    CrossrefPubMedGoogle Scholar
  • 26 Abu Jawdeh EG, Martin RJ, Dick TE, Walsh MC, Di Fiore JM. The effect of red blood cell transfusion on intermittent hypoxemia in ELBW infants. J Perinatol 2014; 34 (12) 921-925
    CrossrefPubMedGoogle Scholar
  • 27 Nitzan I, Hammerman C, Mimouni FB, Bin-Nun A. Packed red blood cells transfusion in neonates: effect on FiO2 and PaO2/SaO2 ratio, and implications for neonatal saturation targeting. J Perinatol 2018; 38 (06) 693-695
    CrossrefPubMedGoogle Scholar
  • 28 Mizuno K, Nishida Y, Taki M. et al. Infants with bronchopulmonary dysplasia suckle with weak pressures to maintain breathing during feeding. Pediatrics 2007; 120 (04) e1035-e1042
    CrossrefPubMedGoogle Scholar
  • 29 Feiner JR, Finlay-Morreale HE, Toy P. et al. High oxygen partial pressure decreases anemia-induced heart rate increase equivalent to transfusion. Anesthesiology 2011; 115 (03) 492-498
    CrossrefPubMedGoogle Scholar
  • 30 Duan J, Kong X, Li Q. et al. Association between anemia and bronchopulmonary dysplasia in preterm infants. Sci Rep 2016; 6: 22717
    CrossrefPubMedGoogle Scholar
  • 31 Clark RH, Tolia VN. The use of oxygen at discharge: is it safe? Is it effective?. Pediatrics 2019; 143 (05) e20190372
    CrossrefPubMedGoogle Scholar
  • 32 Prabhakar V, Hasenstab KA, Osborn E, Wei L, Jadcherla SR. Pharyngeal contractile and regulatory characteristics are distinct during nutritive oral stimulus in preterm-born infants: Implications for clinical and research applications. Neurogastroenterol Motil 2019; 31 (08) 1-7
    CrossrefPubMedGoogle Scholar
  • 33 Jadcherla SR, Prabhakar V, Hasenstab KA. et al. Defining pharyngeal contractile integral during high-resolution manometry in neonates: a neuromotor marker of pharyngeal vigor. Pediatr Res 2018; 84 (03) 341-347
    CrossrefPubMedGoogle Scholar
  • 34 Shubert TR, Sitaram S, Jadcherla SR. Effects of pacifier and taste on swallowing, esophageal motility, transit, and respiratory rhythm in human neonates. Neurogastroenterol Motil 2016; 28 (04) 532-542
    CrossrefPubMedGoogle Scholar
  • 35 Jensen PS, Gulati IK, Shubert TR. et al. Pharyngeal stimulus-induced reflexes are impaired in infants with perinatal asphyxia: DOES maturation modify?. Neurogastroenterol Motil 2017; 29 (07) DOI: 10.1111/nmo.13039.
    CrossrefPubMedGoogle Scholar
  • 36 Jadcherla SR, Pakiraih JF, Hasenstab KA. et al. Esophageal reflexes modulate frontoparietal response in neonates: novel application of concurrent NIRS and provocative esophageal manometry. Am J Physiol Gastrointest Liver Physiol 2014; 307 (01) G41-G49
    CrossrefPubMedGoogle Scholar
  • 37 Fischer HS, Reibel NJ, Bührer C, Dame C. Prophylactic early erythropoietin for neuroprotection in preterm infants: a meta-analysis. Pediatrics 2017; 139 (05) e20164317
    CrossrefPubMedGoogle Scholar
  • 38 Ohls RK, Kamath-Rayne BD, Christensen RD. et al. Cognitive outcomes of preterm infants randomized to darbepoetin, erythropoietin, or placebo. Pediatrics 2014; 133 (06) 1023-1030
    CrossrefPubMedGoogle Scholar
  • 39 ClinicalTrials.gov. Darbepoetin Trial to Improve Red Cell Mass and Neuroprotection in Preterm Infants (Darbe). Accessed September 26, 2019 at: https://www.clinicaltrials.gov/ct2/show/NCT03169881?term=nichd&recrs=a&draw=2&rank=16
    PubMedGoogle Scholar