NEONATAL ANEMIA - AN ETIOLOGIC STUDY - RO LE OF A TIGHT UMBILICAL-CORD LOOP ENCIRCLING THE NECK

Objective: to determine the frequencies of the many causes of neonatal anemia and to emphasize the role of a tight umbilical cord loop aroun d the neck cord. Methods: Hospital discharge reports for patients of a ny gestational age who were admitted to a neonatal unit between 1993 a nd 1995 and had a hemoglobin level lower than 14 g/dl on the first day of life were studied retrospectively. Results: Of the 988 neonates ad mitted during the study period 83 (8.4%) had a hemoglobin level under 14 g/dl. The sex ratio was 1.8. Thirty-six infants were born premature ly. and 26 were delivered by cesarean section, The amniotic fluid was discolored in 30 cases (36%) and blood-tinged intwo (3%;). The Apgar s core was between 3 and7 in 17 infants and was 0 in five infants. Mean hemoglobin level was 11.5 g/dl. Erythroblastosis was seen in 43 cases. Causes were as follows: placental bleeding, n=7; fetomaternal transfu sion, n=3; twin-to-twin transfusion, n=2; hemolytic disease of the new born, n=8. ;G6PD deficiency with elliptocytosis, n=1; maternofetal inf ection, n=8: maternal AZT therapy, n=6; and a tight umbilical cord loo p encircling the neck, n=21. Of the 29 infants in whom no cause was fo und, ten were delivered by cesarean section. Conclusion. A tight umbil ical cord loop encircling the neck causes a substantial proportion of cases of neonatal anemia and should be looked for routinely.