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  • Clinical Research Article
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Hemodynamic adaptation in neonates with early-onset severe anemia during transition period

Pediatric Research (2025)Cite this article

Abstract

Background

To characterize hemodynamics in the first 24 h after birth in neonates with severe anemia.

Method

This was a retrospective analysis of data from a prospective cohort from our critically ill neonate database, that included neonates with severe anemia from December 2022 to June 2024. The results obtained from neonates with severe anemia and the control group were compared.

Results

A total of 21 neonates born at 37 [35.00, 38.00] weeks and weighing 2780 [2350, 3200] grams were included. Compared with the control group, we observed lower peak systolic myocardial velocity in biventricular (left: 5.67 [5.43, 6.48] vs. 6.6 [6.12, 7.32], p < 0.001; right: 6.33 [5.81, 7.50] vs. 8.02 [6.74, 8.86], p < 0.001). A greater ratio of the tricuspid valve early inflow velocity/early diastolic myocardial velocity was noted (6.63 [5.92, 9.27] vs. 5.31 [4.67, 6.55], p < 0.001). The peak systolic blood flow of middle cerebral arteries was greater (left: 55.90 [47.10, 64.90] vs. 44.95 [38.20, 50.95], p = 0.008; right: 52.00 [40.88, 56.15] vs. 45.20 [38.00, 52.00], p = 0.048). The lung ultrasound score was 18.00 [13.5, 25.5].

Conclusion

Neonates with severe anemia are characterized by reduced cardiac systolic function, reduced right diastolic function, increased cerebral blood flow, and pulmonary edema during the transition period.

Clinical trial registration

The study was registered in Chinese Clinical Trial Registry (ChiCTR2200065581; https://www.chictr.org.cn/com/25/showproj.aspx?proj=184095).

Impact

  • This study explored hemodynamic characteristics, including cardiac function, blood flow in middle cerebral arteries, and the lung air/fluid ratio, in neonates with early-onset severe anemia and emphasized impaired cardiac systolic and diastolic function and a hypervolemic state in the pulmonary system and brain during the transition period.

  • These hemodynamic changes are more related to the duration of severe anemia than to the severity of anemia.

  • Given the hemodynamic changes in neonates with severe anemia, volume expansion and transfusion should be optimized.

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Data availability

All the data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

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Acknowledgements

We thank all the staff at Neonatal Critical Ultrasound Collaborative Group. Group information of : Pei Zhang, Women and children’s hospital of Hubei province; Li Feng, Sichuan Jinxin xinan women and children’s hospital; Lina Zeng, Pidu People’s Hospital; Longjun Ren, Women and children’s healthcare hospital of Dujiangyan; Min Xi, Kunming children’s hospital; Xiazi Song, Wenzhou women and children’s hospital; Kai Jie, Fangping Zhang, Qingdao women and children’s hospital; Lin Mei, Yaan people’s hospital; Ailing Su, Nanjing women and children’s healthcare hospital; Linrong Mo, The second affiliated hospital of Guilin medical university; Yongjiang Jiang, Guangzhou women and children’s medical center Liuzhou hospital; Meina Lai, Maoming maternal and child health hospital; Ling Xu, Shuangliu women and children’s healthcare hospital; Xiaobo Zeng, Jiangxi maternal and child health hospital; Lijun Zeng, Foshan women and children hospital; Lili, Yin, General hospital of Ningxia medical university; Yu Wang, Northwest women and children’s hospital; Guina Pan, Panyu maternal and child care service centre of Guangzhou; Jian Wang, Zhangzhou municipal hospital of Fujian province; Zhen Tian, Ningxia women and children’s healthcare hospital; Jiping Luo, Xichang people’s hospital; Xiaoyan Ma, Neimenggu women and children’s healthcare hospital; Qingmei Huang, The second affiliated hospital of Guangxi medical university.

Funding

This research is funded by the Chengdu Medical Scientific Research Project 2023010.

Author information

Author notes

  1. These authors contributed equally: Yiyong Fu, Biao Li, Jingyi Zhang.

  2. These authors jointly supervised this work: Rong Ju, Tiantian Xiao

Authors and Affiliations

  1. Department of Neonatology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Yiyong Fu, Biao Li, Jingyi Zhang, Xiaohong Luo, Huaying Li, Xiaofeng Zhou, Linping Zhong, Lin Zhu, Gaoyang Qin, Xiaolong Zhang, Minsheng Zheng, Youning Hu, Shuqiang Gao, Xuhong Hu, Rong Ju & Tiantian Xiao

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  1. Yiyong Fu
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Contributions

T.X. and R.J. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: T.X., R.J., Y.F., B.L., and J.Z., Acquisition, analysis, or interpretation of data: T.X., R.J., Y.F., B.L., J.Z., X.L., H.L., X.Z., L.Z., L.Z., G.Q., X.Z., M.Z., Y.H., S.G., and X.H. Drafting of the manuscript: Y.F., B.L., and J.Z. Critical review of the manuscript for important intellectual content: T.X., R.J., Y.F., B.L., J.Z., X.L., H.L., X.Z., L.Z., L.Z., G.Q., X.Z., M.Z., Y.H., S.G., and X.H. Statistical analysis: Y.F., B.L., J.Z., X.L., H.L., X.Z., L.Z., L.Z., and G.Q. Administrative, technical, or material support: X.Z., M.Z., Y.H., S.G., and X.H. Supervision: T.X. and R.J.

Corresponding authors

Correspondence to Rong Ju or Tiantian Xiao.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study involves human participants and was approved by the Research Ethics Committee of the Chengdu Women’s and Children’s Central Hospital (No. 2022(104)). Participants gave informed consent to participate in the study before taking part.

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Fu, Y., Li, B., Zhang, J. et al. Hemodynamic adaptation in neonates with early-onset severe anemia during transition period. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04574-0

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