Menu Expand
Neonatal Hematology and Transfusion Medicine, An Issue of Clinics in Perinatology, E-Book

Neonatal Hematology and Transfusion Medicine, An Issue of Clinics in Perinatology, E-Book

Robert D. Christensen

(2015)

Additional Information

Book Details

Abstract

Recent advances in neonatal hematology, largely made by the authors of these chapters, are likely to generate wide spread and long-term improvements in outcomes, as well as reductions in costs of care. Publication of these advances in a single volume will facilitate dissemination of these techniques and practices. The advances include neuroprotection from erythropoietic stimulators, improved guidelines for platelet transfusions, evidence-based guidelines for FFP administration, improved diagnostic methods for genetic causes of severe neonatal jaundice, more accurate definitions of hematological perturbations in necrotizing enterocolitis and sepsis, and reduction in transfusions and in IVH rates by cord milking/delayed clamping.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Neonatal Hematology\rand Transfusion Medicine i
Copyright ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents vii
Foreword: Neonatal Hematology and Transfusion Medicine: What We Can Learn from Pediatric Oncology Groups vii
Preface: The Expanding Evidence Base to Guide Neonatal Hematology and Transfusion Medicine Practice vii
Erythropoietin and Neonatal Neuroprotection vii
Reference Intervals in Neonatal Hematology vii
Neonatal Transfusion Medicine: Five Major Unanswered Research Questions for the Twenty-First Century vii
Hemolytic Disorders Causing Severe Neonatal Hyperbilirubinemia viii
Plasma Biomarkers of Oxidative Stress in Neonatal Brain Injury viii
Umbilical Cord Blood—An Untapped Resource: Strategies to Decrease Early Red Blood Cell Transfusions and Improve Neonatal Ou ... viii
Darbepoetin Administration in Term and Preterm Neonates viii
Immunologic and Hematological Abnormalities in Necrotizing Enterocolitis ix
Hematologic Aspects of Early and Late-Onset Sepsis in Preterm Infants ix
Stem Cells: Potential Therapy for Neonatal Injury? ix
Platelet Transfusions in the Neonatal Intensive Care Unit ix
Neonatal Platelet Function ix
Fresh Frozen Plasma Administration in the Neonatal Intensive Care Unit: Evidence-Based Guidelines x
Thrombosis in the Neonatal Intensive Care Unit x
CME Accreditation Page xi
PROGRAM OBJECTIVE xi
TARGET AUDIENCE xi
LEARNING OBJECTIVES xi
ACCREDITATION xi
DISCLOSURE OF CONFLICTS OF INTEREST xi
UNAPPROVED/OFF-LABEL USE DISCLOSURE xi
TO ENROLL xii
METHOD OF PARTICIPATION xii
CME INQUIRIES/SPECIAL NEEDS xii
Foreword: Neonatal Hematology and Transfusion Medicine: What We Can Learn from Pediatric Oncology Groups xv
REFERENCES xvii
Preface: The Expanding Evidence Base to Guide Neonatal Hematology and Transfusion Medicine Practice xix
Erythropoietin and Neonatal Neuroprotection 469
Key points 469
INFANTS AT RISK FOR NEURODEVELOPMENTAL IMPAIRMENT 469
Preterm Brain Injury 470
Hypoxic-Ischemic Encephalopathy 471
MECHANISMS OF CELL DEATH 471
ERYTHROPOIETIN AS A NEUROPROTECTIVE AGENT FOR NEONATAL NEUROPROTECTION 473
MECHANISM OF ACTION 473
In Vitro and In Vivo Studies 473
CLINICAL TRIALS OF ERYTHROPOIETIN IN NEONATAL POPULATIONS 474
SUMMARY OF ANIMAL AND HUMAN STUDIES 475
REFERENCES 476
Reference Intervals in Neonatal Hematology 483
Key points 483
REFERENCE INTERVALS 483
METHODOLOGY 484
INDIVIDUAL REFERENCE INTERVALS 484
REFERENCES 497
Neonatal Transfusion Medicine 499
Key points 499
INTRODUCTION 499
What Is the Optimal Red Blood Cell Transfusion Threshold for Neonates? 500
What Is the Optimal Platelet Transfusion Threshold for Neonates? 501
Does the Storage Age of a Red Blood Cell Unit Affect Clinical Outcomes for Neonates? 503
Does Red Blood Cell Transfusion Contribute to the Pathogenesis of Necrotizing Enterocolitis? 503
Which New Practices Should Be Used to Prevent Transfusion-Transmitted Infections in Neonates? 504
SUMMARY 506
ACKNOWLEDGMENTS 506
REFERENCES 507
Hemolytic Disorders Causing Severe Neonatal Hyperbilirubinemia 515
Key points 515
NEONATAL HEMOLYTIC DISORDERS 515
HEMOLYTIC DISORDERS ARE FREQUENTLY RESPONSIBLE FOR EXTREME NEONATAL HYPERBILIRUBINEMIA 516
IDENTIFYING HEMOLYTIC CAUSES OF NEONATAL JAUNDICE 517
RBC Morphology 518
End-Tidal Carbon Monoxide 520
EMA Flow Cytometry 520
Next-Generation Sequencing 522
Algorithm 522
REFERENCES 525
Plasma Biomarkers of Oxidative Stress in Neonatal Brain Injury 529
Key points 529
BACKGROUND 529
PLASMA BIOMARKERS OF OXIDATIVE STRESS 530
Isoprostanes 531
Isofurans 531
Neuroprostanes 531
Neurofurans 531
Non–Protein Bound Iron 532
OXIDATIVE STRESS AND NEONATAL BRAIN INJURY 532
SUMMARY 535
ACKNOWLEDGMENTS 535
REFERENCES 535
Umbilical Cord Blood—An Untapped Resource 541
Key points 541
INTRODUCTION 541
DELAYED CORD CLAMPING OR MILKING OF THE UMBILICAL CORD 542
Transition During Gestation and from Fetal to Neonatal Circulation 542
Neonatal Blood Volume Following Delayed Cord Clamping/Milking of the Umbilical Cord 543
Physiologic Changes in Circulation Following Delayed Cord Clamping/Milking of the Umbilical Cord 545
Neonatal Outcomes After Delayed Cord Clamping/Milking of the Umbilical Cord 545
Risks of delayed cord clamping/milking of the umbilical cord 545
Effect of delayed cord clamping/milking of the umbilical cord on initial resuscitation 546
Benefits of delayed cord clamping/milking of the umbilical cord 546
Obstetric Acceptance of Delayed Cord Clamping/Milking of the Umbilical Cord 546
USE OF UMBILICAL CORD BLOOD FOR INITIAL LABORATORY TESTING 547
Placental Anatomy 547
Laboratory Tests Performed on Umbilical Cord Blood 547
Complete blood count 547
Blood culture 550
Blood type and antibody screen 550
Newborn metabolic screen 550
Procedure for Umbilical Cord Blood Sampling 551
Neonatal Outcomes 552
SUMMARY 552
ACKNOWLEDGMENTS 552
REFERENCES 553
Darbepoetin Administration in Term and Preterm Neonates 557
Key points 557
INTRODUCTION 557
CLINICAL STUDIES 558
DARBE DOSING AND PHARMACOKINETICS 559
PRETERM ERYTHROPOIESIS-STIMULATING AGENT STUDIES 560
PRETERM NEUROPROTECTION 562
TERM NEUROPROTECTION STUDIES 563
SUMMARY 564
REFERENCES 565
Immunologic and Hematological Abnormalities in Necrotizing Enterocolitis 567
Key points 567
INTRODUCTION 568
IMMUNOLOGIC ASPECTS OF NECROTIZING ENTEROCOLITIS 568
Mucosal Sensitivity to Bacterial Products in the Premature Intestine 568
Intestinal Epithelium 568
Intestinal Macrophages and Dendritic Cells 569
Mucosa-Associated Lymphoid Tissue 569
T Lymphocytes in the Lamina Propria and Intraepithelial Compartments 570
B Cells and Secretory Immunoglobulins 570
Platelet-Activating Factor 571
Nitric Oxide 571
Reactive Oxygen Species 572
Transforming Growth Factor-β 572
Cytokine Responses Associated with Necrotizing Enterocolitis 573
HEMATOLOGICAL MANIFESTATIONS OF NECROTIZING ENTEROCOLITIS 573
Platelet Counts 573
Coagulopathy 574
Anemia 574
Neutrophils 575
Macrophages and Monocytes 575
Eosinophils 576
Basophils 576
Lymphocytes 576
Nucleated Red Blood Cells 576
SUMMARY 577
REFERENCES 578
Hematologic Aspects of Early and Late-Onset Sepsis in Preterm Infants 587
Key points 587
INTRODUCTION 587
Red Blood Cells 588
Leucocytes 588
Neutrophils 588
Lymphocytes 590
Platelets 591
SUMMARY 593
REFERENCES 593
Stem Cells 597
Key points 597
INTRODUCTION 597
STEM CELL BIOLOGY: A BRIEF REVIEW 598
Stem Cell Theory: Pluripotent Stem Cells and Tissue-Specific Somatic Stem Cells 598
Hematopoietic Stem Cell Development in Mouse and Human Embryos 600
Mesenchymal Stem Cells 601
Endothelial Progenitors: Endothelial Colony-Forming Cells 601
Inducible Pluripotent Stem Cells and Inducible Pluripotent Stem Cell–Derived Endothelial Colony-Forming Cells 602
STEM CELLS FOR THE TREATMENT OF POSTINSULT INJURY IN NEONATES 602
Brain Injury and Stem Cell Transplantation 603
Hypoxic-ischemic encephalopathy 603
Neonatal stroke 603
Lung Injury and Stem Cell Transplantation 604
Intestinal Injury and Stem Cell Transplantation 604
UTILITY OF NEONATAL STEM CELL TRANSPLANTATION: GENERAL CONSIDERATIONS 604
SUMMARY 605
REFERENCES 606
Platelet Transfusions in the Neonatal Intensive Care Unit 613
Key points 613
INTRODUCTION 613
PLATELET TRANSFUSION PRACTICES 614
PRIMARY HEMOSTASIS IN THE NEONATE 616
RELATIONSHIP BETWEEN SEVERITY OF THROMBOCYTOPENIA AND BLEEDING RISK 617
DO PLATELET TRANSFUSIONS DECREASE THE INCIDENCE OF BLEEDING? 618
CURRENT RECOMMENDATIONS 619
FUTURE DIRECTIONS 619
REFERENCES 621
Neonatal Platelet Function 625
Key points 625
INTRODUCTION 625
PLATELET PRODUCTION IN NEONATES 626
PLATELET FUNCTION IN NEONATES 627
DISORDERS OF NEONATAL PLATELET FUNCTION 628
EVALUATION OF PLATELET FUNCTION IN NEONATES 631
Platelet Aggregometry 631
Flow Cytometric Evaluation of Platelet Activation 632
Whole-Blood Hemostasis: Bleeding Time, Surface Coverage, and Closure Time 633
Thromboelastogram and Rotating Thromboelastogram 634
REFERENCES 635
Fresh Frozen Plasma Administration in the Neonatal Intensive Care Unit 639
Key points 639
INTRODUCTION 639
EPIDEMIOLOGY OF FRESH FROZEN PLASMA USE IN THE NEONATAL INTENSIVE CARE UNIT 640
RECOMMENDATIONS DERIVED FROM CLINICAL STUDIES ON THE APPROPRIATE USE OF FRESH FROZEN PLASMA IN NEONATES 640
EFFECT OF FRESH FROZEN PLASMA DOSE ON CLOTTING TIMES 642
IMPLICATIONS OF HEMOSTASIS ASSESSMENT IN THERAPEUTIC DECISION-MAKING FOR FRESH FROZEN PLASMA ADMINISTRATION 644
STRATEGIES TO IMPROVE COMPLIANCE WITH FRESH FROZEN PLASMA ADMINISTRATION GUIDELINES IN THE NEONATAL INTENSIVE CARE UNIT 646
SUMMARY 647
REFERENCES 648
Thrombosis in the Neonatal Intensive Care Unit 651
Key points 651
INTRODUCTION 651
NEONATAL HEMOSTASIS 652
TYPES AND LOCATIONS OF NEONATAL THROMBOSES 652
Arterial Thromboses 652
Perinatal arterial ischemic stroke 652
Iatrogenic arterial thrombosis 653
Spontaneous arterial thrombosis 653
Venous Thromboses 653
Central venous catheter–related thrombosis (excluding intracardiac) 653
Intracardiac thromboses not associated with congenital heart disease 656
Renal vein thrombosis 656
Portal vein thrombosis 656
Cerebral sinovenous thrombosis 657
Thrombosis in Infants with Congenital Heart Disease 657
RISK FACTORS FOR NEONATAL THROMBOSES INCLUDING APPROPRIATE LABORATORY EVALUATION 658
Laboratory Evaluation 658
MANAGEMENT OF THROMBOSIS 659
Nitroglycerin 662
Anticoagulation 662
Unfractionated Heparin 663
Low-Molecular-Weight Heparin 664
Thrombolysis 665
Surgery 665
SUMMARY 666
REFERENCES 667
Index 675