Pediatrics

Abstract

Summary This prospective randomized controlled trial demonstrated that delayed cord clamping (DCC) at birth reduces neonatal anemia. The authors suggest that the common practice of clamping the umbilical cord immediately after birth may deprive the newborn of benefits such as an increase in iron stores, with clinical implications for the infant’s first year of life.

Summary In this study the authors report iron metabolism findings from their previously reported prospective randomized controlled open label trial investigating the effectiveness of intravenous (IV) iron (Fe) combined with erythropoietin (EPO) in stimulating erythropoiesis in premature infants (Pollak et al).

Summary Lin and colleagues from Taiwan present their experience with blood conservation in pediatric patients undergoing major hepatectomy. They describe their pre-, intra- and postoperative management of 14 patients. The mean age was 3.1 years (range 0.67 – 7.60 years) and the mean body weight 14 kg (range 8-26 kg). Mean intraoperative blood loss was 68 ml (range 1.25 – 13.0 ml/kg) with no intraoperative blood transfusions administered.

Summary Given that several factors impact on erythropoiesis in the anemia of prematurity and the lack of data on combined therapy with erythropoietin (EPO), iron, folate and vitamin B12, Haigen et al conducted this randomized controlled trial to compare vitamin B12 and high-dose folate supplementation with low-dose folate supplementation alone in premature infants receiving EPO and iron. 64 premature infants (birth weights between 801 g and 1300 g and ≤ 32 weeks gestational age) were randomly assigned to one of two groups, a treatment group and a control group.

Summary This multicenter (n=27) randomized, double-blind, placebo-controlled trial enrolled children with cancer (solid tumors, Hodgkin’s disease, acute lymphoblastic leukemia or non-Hodgkin’s lymphoma) and who were anemic and receiving myelosuppressive chemotherapy. The trial’s objective was to assess the effects of a once-weekly dose of epoetin alfa (EPO) on health-related quality of life (HRQOL), hemoglobin (Hb) levels and red blood cell (RBC) transfusions in this group of patients. Outcome measures also included adverse events.

Summary This randomized controlled trial assessed the safety of hypertonic-hyperoncotic solution (HHS) and its hemodynamic effect in children following cardiac surgery with cardiopulmonary bypass for repair of congenital heart defects. 50 consecutive children meeting study criteria were enrolled and randomized to receive either HHS (7.2% sodium chloride with 6% hydroxyethyl starch 200) or isotonic saline solution (0.9% sodium chloride) in the pediatric intensive care unit immediately following surgery to repair atrial or ventricular septal defects. 25 patients made up each group.

Summary   This multicenter randomized controlled trial found no indication of harm from a restrictive transfusion threshold in acutely ill extremely low birth weigh infants. 10 international centers participated in this trial comparing clinical outcomes in 451 extremely low birth weight infants (<1000 g) randomly assigned during the first two days of life to either a restrictive (low) or a liberal (high) transfusion threshold algorithm. Hemoglobin level transfusion thresholds varied according to age and level of respiratory support needed.

Summary Studies in extremely low birth weight (ELBW) infants have yielded mixed and disappointing results with regard to erythropoietin therapy reducing transfusion requirements. This randomized controlled trial by Haiden and colleagues found combined therapy with erythropoietin, intravenous (IV) iron, high-dose folate and vitamin B12 reduced the transfusion rate by one third compared with controls in ELBW infants (68% transfused in the treatment group versus 95% in the control group).

Summary Based on the results of the TRICC trial in adults (Hebert et al., 1999) the authors of this study compared a traditional (liberal) versus a restrictive transfusion policy in pediatric burn patients. They hypothesized that a restrictive transfusion policy in pediatric burn patients would result in reduced transfusion requirements while having no effect on morbidity and mortality.