Partial exchange transfusion in the neonate born at high altitudes (2350 meters above sea level) is a cause of anaemia in infants

Abstract

Introduction: Polycythemia, its diagnosis and treatment, is widely known. In our environment, the neonates born at high altitudes are treated using the same criteria as those born at sea level. There is a ATNB with AWGA group, who look undernourished and it is frequent to detect polycythemia in them, with physiopathological consequences. Partial exsanguinotransfusion (PET) in order to get to a hematocrit of 55%, with sodium chloride at 9o/ oo, is the standard treatment. Another problem in the breastfed child is the progressive decrease of Hb values, with great repercussion starting at 5 or 6 months. The evolution of patients born at high altitudes who were treated with PET and its connection with anemia is not known, being this the purpose of this paper.

Materials and methods: The sample consisted of all the newborns at the Neonatology Ward at Honorio Delgado Hospital in the city of Arequipa (2,350 m.a.s.l.) between July 17, 2006 and December 20, 2007, date of the last follow-up examination. The CASE group comprised 26 undernourished fetal patients with a hematocrit greater than 65% and who received PET; there were two CONTROL groups, one consisting of 26 ATNB with AWGA, healthy normal levels of hematocrit (healthy control) and another group with 25 ATNB with AWGA patients with fetal undernourishment and without polycythemia (dysmature control). Each patient, after the first, the third and the sixth months was performed a checkup and anthropometry. Nutritional information regarding the benefits of exclusive breastfeeding until the six months of age was provided and the levels of hemoglobin and ferritin were measured.

Results: A month after birth, hemoglobin was statistically similar among the three groups. In the dysmature control group, hemoglobin did not show any variation in time. In the healthy control group, hemoglobin significantly decreased after the third month, similar to the cases (p < 0,05). The difference between the dysmature controls and the cases was statistically significant. After the sixth month, while the healthy controls recovered their hemoglobin value, the healthy cases showed a constant decrease in their values, significant in relation to the controls (p < 0,05). There was a reduction in the ferritin in the three study groups, but such decrease was significantly lower in children treated with partial exchange transfusion, both after 3 as well as after 6 months. The ferritin levels in the cases were significantly different (p = 0,01) after 3 months in relation to the healthy control group, and remained the same after the sixth month (p = 0,01)

Conclusions: At the sixth month, the cases developed ferropenic anemia and showed mild iron deficiency in comparison with the healthy control. There is twice much risk of causing anemia in the breastfed child after PET is performed in the cases compared with the dysmature control.