Abstract
Background
Fetal hypoxia has been implicated in fetal growth restriction in congenital heart disease (CHD) and leads to stress erythropoiesis in utero. The objective is to assess erythropoiesis and its association with growth in newborns with CHD.
Methods
Fetuses with prenatally diagnosed CHD from 2013 to 2018 were retrospectively reviewed. Pregnancies with multiple gestation, genetic abnormalities, major extra-cardiac anomalies, and placental abruption were excluded. Complete blood count tests at birth were compared to published normative values. Spearman correlation assessed associations of red blood cell (RBC) indices with birth anthropometrics and prenatal Doppler measures.
Results
A total of 160 newborns were included. Median gestational age was 38.3 (37.3, 39.0) weeks. Infants ≥37 weeks gestation had lower hemoglobin (Hgb), hematocrit, and elevated nucleated RBC (nRBC), mean corpuscular volume, and mean corpuscular hemoglobin compared to reference. No differences in RBC indices were observed in infants <34 and 34–37 weeks gestation. There was no difference in Hgb and nRBC between CHD subgroups. Neither Hgb nor nRBC were associated with birth anthropometrics or Doppler patterns.
Conclusions
Term infants with CHD demonstrated multiple alterations in erythrocyte indices suggesting ineffective stress erythropoiesis in late gestation resulting in lower Hgb at birth. Altered erythropoiesis was not correlated to growth or Doppler patterns.
Impact
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Newborns with congenital heart disease (CHD) born at term gestation demonstrated altered erythropoiesis.
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Term newborns with CHD have decreased hemoglobin levels despite having red blood cell indices consistent with stress erythropoiesis, suggesting an incomplete compensatory response to in utero physiologic disturbances associated with CHD.
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The etiology is unknown; however, it may be influenced by multiple risk factors during pregnancy in the maternal–fetal dyad.
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Alterations in red blood cell indices were not associated with outcomes of fetal growth.
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Each author has met authorship requirements. S.Y.T. conceptualized and designed the study, acquired data, performed data interpretation, and drafted and critically revised the manuscript. Z.G. and N.J.O. assisted with study design, carried out data analyses and interpretation, and critically revised the manuscript. T.A.K. and S.T. assisted with study design and critically revised the manuscript. R.K. collected data and reviewed the manuscript. J.F.C. conceptualized and designed the study, coordinated and supervised data collection and data analysis, performed data interpretation, and critically revised the manuscript. All authors approved the final version for publication.
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Patient consent was not required for this study. Approval was obtained from the Institutional Review Board at Cincinnati Children’s Hospital Medical Center with waiver of consent due to the retrospective nature of the study.
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Tseng, S.Y., Gao, Z., Kalfa, T.A. et al. Altered erythropoiesis in newborns with congenital heart disease. Pediatr Res 91, 606–611 (2022). https://doi.org/10.1038/s41390-021-01370-4
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DOI: https://doi.org/10.1038/s41390-021-01370-4
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