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What is the safe HB for the newborn to be send home?


selvanr4

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In your opinion what is the safe HB at which to send the newborn home ?.

This question arose because we had few newborn who had persistently low HB since birth. We try to keep the haemotocrit to above 45 in sick newborns. Does the same applies here?

dr.r.selvan

Erode, India

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Depends on what baby we talk about.

And we have no written guidelines on this...

In a term well baby in maternity we seldom know Hb/EVF, but if blood samples are indicated (for some reason) and we see an EVF less than 40 and the mother plan exclusive breast feeding we would probably do a follow up, and sometimes also prescribe iron supplementation until we know how the Hb/EVF develops.

In a graduating ex-preterm infant, we usually have a rather high tolerance for lower values, IF the baby is on iron supplementation AND has a documented active erytropoesis (high reticulocyte count). Most of the dr in our units would accept EVFs around 28-32, I personally feel uncomf with EVF less than 28, but as all these infants have recent follow-ups after discharge, we monitor EVF closely.

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  • 1 month later...

I agree with Dr. Johansson about term babies. For preterms, though, we've sent many babies home with a haematocrit as low as 26 when they have high reticulocyte count, are on iron supplementation AND have a good weight gain. These babies would have a very close follow-up (1 week after discharge the haematocrit and weight are checked) and parents would be well orientated about signs of severe anaemia.

I've seen colleagues discharging preterms when EVF is as low as 24, but that would be too much for me to be comfortable with the situation.

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