The nurse observed a pool of blood underneath the baby’s back upon lifting the polyethylene wrap. At five minutes of life, he was noted to be pale and cold. The Apgar scores were 4, 6, and 7 at 1, 5, and 10 minutes of life, respectively. A polyethylene wrap was placed over the baby, and he was intubated within few minutes for poor respiratory effort. The delivery was attended by the neonatal resuscitation team, and resuscitation was performed in the standard manner. The pregnancy was complicated by a history of maternal substance abuse (marijuana) and premature prolonged rupture of membranes. Case PresentationĪ 24-week-gestation infant, a product of a dichorionic-diamniotic twin pregnancy, was born by spontaneous vaginal delivery after breech presentation to a 29-year-old G3P0 female.
This preventable cause of acute postnatal blood loss has not been emphasized in the literature before and may be more common than previously recognized.
However, there is a paucity of literature on causes of neonatal blood loss during or immediately after delivery, particularly those related to bleeding from the umbilical cord at the time of birth. Posthemorrhagic anemia in the newborn can result from antenatal, intrapartum, or postnatal causes. We believe that umbilical cord bleeding from errors in cord clamping could be an important cause of acute blood loss in the delivery room and that it may result in significant clinical morbidity, especially in extremely premature infants. This case report describes a preterm infant who developed severe anemia and shock immediately after delivery related to an acute hemorrhage through patent umbilical cord vessels secondary to a tear in the umbilical cord at the site of cord clamping. Most cases of posthemorrhagic anemia are reported from fetomaternal hemorrhage or umbilical cord accidents in utero.
Posthemorrhagic anemia is a rare but important cause of anemia in neonates, second only to hemolytic anemia of newborn.
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