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Bianchi M, Papacci P, Valentini CG, Barbagallo O, Vento G, Teofili L. Umbilical cord blood as a source for red-blood-cell transfusion in neonatology: a systematic review. Vox Sang 2018; 113:713-725. [PMID: 30328121 DOI: 10.1111/vox.12720] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/28/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
Abstract
The prevention and treatment of anaemia in newborn patients made tremendous progress in the last decades. However, red-blood-cell (RBC) transfusions remain unavoidable in many neonates candidate to surgery and especially in preterm infants. In particular, anaemia occurring in neonates born at extremely low gestational age is actually severe and frequently requires transfusions. Several approaches have been explored to prevent or even to reduce the threshold and the frequency of RBC transfusions. Among these, umbilical cord blood (UCB) collection and processing to obtain RBC components for autologous or allogeneic transfusion have been extensively investigated. In this systematic review, we revised the literature concerning the use of UCB for either autologous or allogeneic transfusion purposes and we illustrated the rationale for a transfusion therapy tailored to extremely preterm neonates, based on RBC concentrates from allogeneic UCB donations.
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Affiliation(s)
- Maria Bianchi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Banca del sangue di cordone ombelicale UNICATT, Rome, Italy
| | - Patrizia Papacci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Terapia Intensiva Neonatale, Rome, Italy
| | - Caterina Giovanna Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Banca del sangue di cordone ombelicale UNICATT, Rome, Italy
| | - Ombretta Barbagallo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Banca del sangue di cordone ombelicale UNICATT, Rome, Italy
| | - Giovanni Vento
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Terapia Intensiva Neonatale, Rome, Italy
| | - Luciana Teofili
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Banca del sangue di cordone ombelicale UNICATT, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Red Cell Transfusion Practices in Neonatal Intensive Care Unit: An Experience from Tertiary Care Centre. Indian J Hematol Blood Transfus 2018; 34:671-676. [PMID: 30369739 DOI: 10.1007/s12288-018-0959-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/07/2018] [Indexed: 10/17/2022] Open
Abstract
Red cells are the most often transfused blood components during the neonatal period. The aim of the present study was to obtain information regarding the relationship of red cell transfusion with clinical outcomes and to evaluate red cell transfusion practices in neonatal centre of a tertiary care centre. The clinical history, blood component details and laboratory parameters were evaluated with clinical outcomes. The neonates requiring transfusion of red cells were then followed up in the Blood bank for various laboratory parameters. Clinical parameters and clinical outcome were noted from case files. During the study period, 291 neonates were admitted in NICU. 2 neonates were excluded as they were congenitally malformed. Out of 289 admitted neonates, 61 neonates (21.1%) received blood and blood component transfusions. Out of 61 neonates, 20 received red cell transfusions. Mean donor exposure of red cells was 1.2. The mean volume of transfused red cell was 39.6 ml with mean age of red cells was 3.6 days. The mean pre- and post-transfusion Hct was 25.3 and 30.4%, respectively. The most common indication for red cell transfusion was low haemoglobin. There was a significant increase in lactate level and decrease in base excess in transfused neonates. However, no statistically significant correlations were found between transfusions and neonatal weight gain, apnoea, respiratory support and mortality. Transfusion of red cells has significant effect on laboratory parameters as compared to clinical parameters such as weight gain, episodes of apnoea and respiratory support.
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Smoking fewer than 20 cigarettes per day and remaining abstinent for more than 12 hours reduces carboxyhemoglobin levels in packed red blood cells for transfusion. PLoS One 2018; 13:e0204102. [PMID: 30256832 PMCID: PMC6157890 DOI: 10.1371/journal.pone.0204102] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 09/04/2018] [Indexed: 01/01/2023] Open
Abstract
Background The prevalence of smokers among blood donors and the effect of smoking on the quality of donated blood have not been extensively explored. In the present study, we determined the prevalence of smoker donors in a large blood bank in Southern Brazil and evaluated the quality of packed red blood cells (RBCs) from these donors through recommended quality control tests and measurement of carboxyhemoglobin (COHb) levels. We then assessed the influence of smoking habits and abstinence before donation on these parameters. Material and methods An observational study was conducted to determine the prevalence of smoking donors, while a prospective cohort study compared conventional hematological and serological parameters and COHb levels at 0, 15, and 30 days after donation in RBCs donated by smokers (N = 31) and nonsmokers (N = 31) and their association with smoking habits and abstinence before donation. Results Of 14,428 blood donations received in 1 year, 5.9% were provided by smokers. Storage over time slightly altered some quality parameters, such as hematocrit, hemoglobin, hemolysis, and COHb levels, in RBC packs. COHb levels were higher in RBC packs from smokers (8%) than from non-smokers (2%), and increased as a function of the number of cigarettes smoked daily and time elapsed since the last cigarette smoked before donation. Lower levels were found in RBC packs from donors who smoked fewer than 20 cigarettes per day or remained abstinent for more than 12h before giving blood. Conclusion Although cigarette smoke had no significant effect on blood quality parameters such as hematocrit, hemoglobin, or hemolysis, it quadrupled COHb levels in packed RBCs. Abstinence from smoking for more than 12h or smoking fewer than 20 cigarettes daily helped decrease COHb levels. Implications Given the increasing prevalence of tobacco use worldwide, we suggest blood banks recommend 12h of tobacco abstinence before donation and analyze COHb levels in donated blood as an approach to reduce risk for high-risk recipients.
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Kim DH. Transfusion practice in neonates. KOREAN JOURNAL OF PEDIATRICS 2018; 61:265-270. [PMID: 30185018 PMCID: PMC6172519 DOI: 10.3345/kjp.2018.06849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/06/2018] [Indexed: 11/29/2022]
Abstract
Neonates, especially extremely low birth weight infants, are among the groups of patients undergoing transfusion frequently. Since they are exposed to higher specific transfusion risks compared to the patients of other age groups, there are many special aspects that must be considered for transfusion therapy in neonates. The transfusion risks in neonates include adverse outcomes specific for preterm infants as well as increased metabolic, immunologic, and infectious complications. To reduce the risks of transfusion-transmitted cytomegalovirus infection and transfusion-associated graft-versus-host disease, leukoreduced and irradiated cellular blood products should be used for all neonates. This review summarizes the risks of neonatal transfusion therapy, specific methods to reduce risk, and current trends and practices of red blood cell and platelet transfusions in neonates, to facilitate decision-making for neonatal transfusion.
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Affiliation(s)
- Do-Hyun Kim
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
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Abstract
OBJECTIVES To determine the prevailing hemoglobin levels in PICU patients, and any potential correlates. DESIGN Post hoc analysis of prospective multicenter observational data. SETTINGS Fifty-nine PICUs in seven countries. PATIENTS PICU patients on four specific days in 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients' hemoglobin and other clinical and institutional data. Two thousand three hundred eighty-nine patients with median age of 1.9 years (interquartile range, 0.3-9.8 yr), weight 11.5 kg (interquartile range, 5.4-29.6 kg), and preceding PICU stay of 4.0 days (interquartile range, 1.0-13.0 d). Their median hemoglobin was 11.0 g/dL (interquartile range, 9.6-12.5 g/dL). The prevalence of transfusion in the 24 hours preceding data collection was 14.2%. Neonates had the highest hemoglobin at 13.1 g/dL (interquartile range, 11.2-15.0 g/dL) compared with other age groups (p < 0.001). The percentage of 31.3 of the patients had hemoglobin of greater than or equal to 12 g/dL, and 1.1% had hemoglobin of less than 7 g/dL. Blacks had lower median hemoglobin (10.5; interquartile range, 9.3-12.1 g/dL) compared with whites (median, 11.1; interquartile range, 9.0-12.6; p < 0.001). Patients in Spain and Portugal had the highest median hemoglobin (11.4; interquartile range, 10.0-12.6) compared with other regions outside of the United States (p < 0.001), and the highest proportion (31.3%) of transfused patients compared with all regions (p < 0.001). Patients in cardiac PICUs had higher median hemoglobin than those in mixed PICUs or noncardiac PICUs (12.3, 11.0, and 10.6 g/dL, respectively; p < 0.001). Cyanotic heart disease patients had the highest median hemoglobin (12.6 g/dL; interquartile range, 11.1-14.5). Multivariable regression analysis within diagnosis groups revealed that hemoglobin levels were significantly associated with the geographic location and history of complex cardiac disease in most of the models. In children with cancer, none of the variables tested correlated with patients' hemoglobin levels. CONCLUSIONS Patients' hemoglobin levels correlated with demographics like age, race, geographic location, and cardiac disease, but none found in cancer patients. Future investigations should account for the effects of these variables.
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Shanmugha Priya RA, Krishnamoorthy R, Panicker VK, Ninan B. Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: A descriptive study. Asian J Transfus Sci 2018; 12:34-41. [PMID: 29563673 PMCID: PMC5850695 DOI: 10.4103/ajts.ajts_148_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Lack of recent studies focusing on indications, pattern, and benefits of transfusions in low birth weight (B.Wt) and low gestational age (GA) preterm neonates prompted us to undertake this study. AIM: To estimate the transfusion requirements and outcomes in preterm neonates <1500 g and/or <32 weeks. SETTINGS AND DESIGN: This is a cross-sectional study conducted over a period of 2 years in a tertiary care center. MATERIALS AND METHODS: This study was conducted with 101 preterm neonates <1500 g and/or <32 weeks who received blood transfusions in the Neonatal Intensive Care Unit. Restrictive pattern of transfusion was followed. Demographic details and antenatal, neonatal, laboratory, and transfusion parameters were collected. STATISTICAL ANALYSIS USED: Statistical analyses were performed using SPSS 16. RESULTS: The study participants received 311 transfusions. Transfusion requirements decreased with increasing GA and B.Wt. Majority of blood transfusions occurred during the first 2 weeks of life. Packed red blood cells (PRBCs) were the most frequent blood components transfused. Ninety-six percent of the study population had an uneventful transfusion. Mean hemoglobin improvement after PRBC transfusions was 2.3 ± 2.1 g/dl. Improvement in apnea occurred in 76% PRBC transfusions. Infants with sepsis, patent ductus arteriosus, bronchopulmonary dysplasia, disseminated intravascular coagulation, and dyselectrolytemia received more number of transfusions. CONCLUSION: This study would serve as an audit for neonatal blood transfusion therapy. Close adherence to neonatal transfusion policy and restrictive transfusion guidelines helps reduce inappropriate use of blood products and adverse transfusion reactions.
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Affiliation(s)
- R A Shanmugha Priya
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - R Krishnamoorthy
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Vinod Kumar Panicker
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Hwang JS, Rehan VK. Recent Advances in Bronchopulmonary Dysplasia: Pathophysiology, Prevention, and Treatment. Lung 2018; 196:129-138. [PMID: 29374791 DOI: 10.1007/s00408-018-0084-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/04/2018] [Indexed: 12/16/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is potentially one of the most devastating conditions in premature infants with longstanding consequences involving multiple organ systems including adverse effects on pulmonary function and neurodevelopmental outcome. Here we review recent studies in the field to summarize the progress made in understanding in the pathophysiology, prognosis, prevention, and treatment of BPD in the last decade. The work reviewed includes the progress in understanding its pathobiology, genomic studies, ventilatory strategies, outcomes, and therapeutic interventions. We expect that this review will help guide clinicians to treat premature infants at risk for BPD better and lead researchers to initiate further studies in the field.
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Affiliation(s)
- Jung S Hwang
- Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Virender K Rehan
- Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1124 West Carson Street, Torrance, CA, 90502, USA.
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Dako J, Buzzard J, Jain M, Pandey R, Groh-Wargo S, Shekhawat P. Slow enteral feeding decreases risk of transfusion associated necrotizing enterocolitis. J Neonatal Perinatal Med 2018; 11:231-239. [PMID: 29843272 DOI: 10.3233/npm-181773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Necrotizing Enterocolitis (NEC) is a multifactorial condition where PRBC transfusion is associated with necrotizing enterocolitis (TANEC) in about a third of all cases of NEC. We have investigated the role of feeding practices in incidence of TANEC. We sought to compare infants diagnosed with TANEC versus infants diagnosed with classic NEC and investigated the effects of a standardized slow enteral feeding (SSEF) protocol on TANEC incidence as well as the effects of SSEF on growth of infants with NEC. METHODS We conducted a retrospective cohort study, where medical records of infants born in a tertiary care neonatal intensive care unit (level IIIb) from January 1997 to May 2014 with birth weight < 1500 grams and gestational age≤34 weeks with NEC stage IIa or greater according to the modified Bell's staging were reviewed. RESULTS During the study period, 111 infants developed NEC, and 41/111 (37%) were diagnosed with TANEC. Infants with TANEC were smaller, more premature, had higher SNAPPE scores and were more anemic prior to transfusion compared with infants with 'classic NEC'. The severity of NEC did not differ between the two groups, however, infants with TANEC had worse outcomes and longer NICU stays. Introduction of SSEF protocol, led to a significant decrease in TANEC. There was no difference in weight and head circumference of infants in the two groups at 2 years corrected age. CONCLUSION SSEF led to a significant reduction in the incidence of TANEC without impairing growth at 2 years corrected age.
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MESH Headings
- Blood Transfusion/methods
- Enteral Nutrition/methods
- Enterocolitis, Necrotizing/etiology
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/therapy
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/therapy
- Infant, Very Low Birth Weight
- Male
- Retrospective Studies
- Risk Factors
- Transfusion Reaction
- Treatment Outcome
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Affiliation(s)
- J Dako
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - J Buzzard
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - M Jain
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - R Pandey
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at Houston, TX, USA
| | - S Groh-Wargo
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - P Shekhawat
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Howarth C, Banerjee J, Aladangady N. Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies. Neonatology 2018; 114:7-16. [PMID: 29550819 DOI: 10.1159/000486584] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/04/2018] [Indexed: 01/21/2023]
Abstract
The current evidence regarding the indication, advantages and risks of red blood cell transfusion (RBCT) for preterm infants is discussed. This is an important area in Neonatology to be examined given that 90% of extremely low birth weight infants receive RBCT and many controversies remain regarding when to transfuse and the risks of RBCT. The various treatment thresholds and guidelines used are presented and we compare the short-term clinical benefits of liberal and restrictive RBCT in preterm infants; the majority of these are equivocal and sadly long-term outcome data is limited. The latest evidence on how anaemia and blood transfusion affect organ perfusion in preterm infants is presented. This is important when trying to establish the optimal trigger threshold for RBCT in preterm infants, especially because the knowledge about the adaptive physiological responses to anaemia in very low birth weight infants and the effects of RBCT at various levels of anaemia is also inadequate. Further research into the physiological adaptive response to anaemia of varying degrees and to RBCT at different levels of anaemia in preterm infants of different gestational and post-natal ages is needed before we can conclusively guide the optimal timing and trigger thresholds for RBCT in preterm infants.
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Affiliation(s)
- Claire Howarth
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
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60
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Kalhan TG, Bateman DA, Bowker RM, Hod EA, Kashyap S. Effect of red blood cell storage time on markers of hemolysis and inflammation in transfused very low birth weight infants. Pediatr Res 2017; 82:964-969. [PMID: 28738026 PMCID: PMC5685900 DOI: 10.1038/pr.2017.177] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/18/2017] [Indexed: 12/19/2022]
Abstract
BackgroundProlonged storage of transfused red blood cells (RBCs) is associated with hemolysis in healthy adults and inflammation in animal models. We aimed to determine whether storage duration affects markers of hemolysis (e.g., serum bilirubin, iron, and non-transferrin-bound iron (NTBI)) and inflammation (e.g., interleukin (IL)-8 and monocyte chemoattractant protein (MCP)-1) in transfused very low birth weight (VLBW) infants.MethodsBlood samples from 23 independent transfusion events were collected by heel stick before and 2-6 h after transfusion.ResultsSerum iron, total bilirubin, NTBI, and MCP-1 levels were significantly increased after transfusion of RBCs (P<0.05 for each comparison). The storage age of transfused RBCs positively correlated with increases in NTBI following transfusion (P<0.001; R2=0.44). No associations between storage duration and changes in the other analytes were observed.ConclusionTransfusion of RBCs into VLBW infants is associated with increased markers of hemolysis and the inflammatory chemokine MCP-1. RBC-storage duration only correlated with increases in NTBI levels following transfusion. NTBI was only observed in healthy adults following 35 days of storage; however, this study suggests that VLBW infants are potentially more susceptible to produce this pathological form of iron, with increased levels observed after transfusion of only 20-day-old RBCs.
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Affiliation(s)
- Tamara G. Kalhan
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10461
| | - David A. Bateman
- Division of Neonatology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York 10032
| | - Rakhee M. Bowker
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY 10032,Correspondence: Eldad A. Hod, M.D., Department of Pathology and Cell Biology, 630 West 168th St, Room P&S 14-434, Laboratory of Transfusion Biology, College of Physicians & Surgeons of Columbia University, New York, NY 10032; Phone: 212-342-5648;
| | - Sudha Kashyap
- Division of Neonatology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York 10032
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Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.6570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Assessment of Mesenteric Tissue Saturation, Oxygen Saturation, and Heart Rate Pre- and Post-Blood Transfusion in Very Low-Birth-Weight Infants Using Abdominal Site Near-Infrared Spectroscopy. Adv Neonatal Care 2017; 17:E3-E9. [PMID: 28787302 DOI: 10.1097/anc.0000000000000417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preterm infants often receive blood transfusions during hospitalization. Although transfusions are intended to enhance oxygen delivery, previous studies found decreases in tissue and mesenteric oxygen saturation during and after blood transfusions without changes in vital signs and hemoglobin oxygen saturation. PURPOSE To study the effect of blood transfusions on regional mesenteric tissue oxygen saturation (rSO2), hemoglobin saturation of oxygen (SpO2), and heart rate (HR) in premature infants. METHOD A prospective, observational, nonrandomized study using a repeated-measures design was done to evaluate changes in physiologic variables (HR, SpO2, rSO2) before, during, and after a blood transfusion in premature infants. RESULTS A convenience sample of 30 infants with a mean gestational age of 25.5 (2.1) weeks was recruited. Repeated-measures analysis of variance found no significant differences in HR (P = .06) and SpO2 (P = .55) over time. However, significant differences occurred in rSO2 over the 3 time periods (P < .001). The rSO2 increased during the transfusion from 40.3% to 41.5%, but decreased to 34.9% in the posttransfusion period. Pairwise comparisons revealed statistically significant mean rSO2 differences between pretransfusion and posttransfusion (P < .001), and during transfusion to posttransfusion (P < .001) periods. IMPLICATIONS FOR RESEARCH This study supports previous findings of perfusion changes during blood transfusions in preterm infants. IMPLICATIONS FOR PRACTICE Measuring mesenteric tissue oxygenation during blood transfusion in very low-birth-weight infants can potentially add another physiologic parameter to guide further clinical assessment and interventions during transfusions.
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Red Blood Cell Transfusion and Clinical Outcomes in Extremely Low Birth Weight Preterm Infants. Pediatr Neonatol 2017; 58:216-222. [PMID: 27514234 DOI: 10.1016/j.pedneo.2016.03.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/11/2016] [Accepted: 03/25/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Red blood cell (RBC) transfusion is often considered a life-saving measure in critically ill neonates. The smallest and least mature infants tend to receive the largest amount of transfusions. RBC transfusion itself has also been suggested as an independent risk factor of poor clinical outcome in critical patients. Our aim is to study if there are associations between RBC transfusion and in-hospital mortality, short-term morbidities, and late neurodevelopmental outcome in extremely low birth weight (ELBW) preterm infants. METHODS A cohort of ELBW preterm infants admitted to our neonatal intensive care unit from January 2009 to December 2010 were recruited. The number of RBC transfusions within 7 days, 30 days, and 60 days of life were recorded. Clinical outcomes including in-hospital mortality, development of retinopathy of prematurity (ROP), necrotizing enterocolitis, chronic lung disease, and later neurodevelopmental outcome were assessed with follow-up of up to 2 years of age. Multivariable logistic regression was used to estimate the associations between RBC transfusion and clinical outcomes. RESULTS A total of 98 ELBW preterm infants survived at the time of discharge. Of these survivors, the mean numbers of RBC transfusions were 2.5 ± 1.7, 7.4 ± 3.1, and 11.3 ± 4.5 times within 7 days, 30 days, and 60 days after birth, respectively. The number of transfusions within 7 days of life was correlated with risk of death before 1 month of age (odds ratio: 1.54, 95% confidence interval: 1.04-2.27, p = 0.03) and the number of transfusions within 30 days was correlated with risk of developing threshold ROP (odds ratio: 1.27, 95% confidence interval: 1.04-1.55, p = 0.02). The number of transfusions within 7 days of life was positively correlated with cognitive performance (Mental Developmental Index score) at 18-24 months of corrected age. CONCLUSION RBC transfusion has a negative impact on survival in ELBW infants. It increases the risk of developing ROP and affects late neurodevelopment. Decisions of blood transfusion in these very immature infants should be made cautiously taking these deleterious results into consideration.
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Treviño-Báez JD, Briones-Lara E, Alamillo-Velázquez J, Martínez-Moreno MI. Multiple red blood cell transfusions and iron overload in very low birthweight infants. Vox Sang 2017; 112:453-458. [PMID: 28516443 DOI: 10.1111/vox.12528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/30/2017] [Accepted: 04/06/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES To estimate the risk of iron overload in very low birthweight (VLBW) infants who receive more than two red blood cell (RBC) transfusions, in comparison with those who receive two or less during their hospital stay. MATERIALS AND METHODS Prospective open cohort study in VLBW infants with >2 (exposed) and ≤2 (non-exposed) RBC transfusions. Ferritin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at birth and after each RBC transfusion. The incidence of iron overload was determined. Risk factors were analysed using a logistic regression model. RBC transfusion volume correlations with ferritin, ALT and AST were calculated with Spearman's rank correlation coefficient, as well as correlations between ferritin and aminotransferases. RESULTS A total of 63 patients were enrolled, 18 of which were exposed and 45 non-exposed. Twelve patients developed severe iron overload, eight exposed (44·5%) vs. four (8·8%) non-exposed (RR: 5, 95% CI: 1·7-14·6). Multivariate analysis showed that the number of transfusions increased the risk of iron overload (OR: 2·07, 95% CI: 1·36-2·14) while a higher one-minute Apgar score was associated with a lower risk (OR: 0·56, 95% CI: 0·32-0·99). Severe iron overload mainly occurred with a transfusion volume higher than 120 ml/kg. There was a positive correlation between ferritin and transfusion (r = 0·53; P < 0·001). CONCLUSION There was a higher risk of iron overload in exposed infants in comparison with non-exposed infants. Severe iron overload in VLBW infants may occur with a total transfusion volume >120 ml/kg.
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Affiliation(s)
- J D Treviño-Báez
- High Specialty Medical Unit No. 23., Hospital of Obstetrics and Gynecology 'Dr. Ignacio Morones Prieto' of the Mexican Institute of Social Security, Monterrey, Nuevo Leon, Mexico
| | - E Briones-Lara
- High Specialty Medical Unit No. 23., Hospital of Obstetrics and Gynecology 'Dr. Ignacio Morones Prieto' of the Mexican Institute of Social Security, Monterrey, Nuevo Leon, Mexico
| | - J Alamillo-Velázquez
- High Specialty Medical Unit No. 23., Hospital of Obstetrics and Gynecology 'Dr. Ignacio Morones Prieto' of the Mexican Institute of Social Security, Monterrey, Nuevo Leon, Mexico
| | - M I Martínez-Moreno
- High Specialty Medical Unit No. 23., Hospital of Obstetrics and Gynecology 'Dr. Ignacio Morones Prieto' of the Mexican Institute of Social Security, Monterrey, Nuevo Leon, Mexico
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Dani C, Poggi C, Gozzini E, Leonardi V, Sereni A, Abbate R, Gori AM. Red blood cell transfusions can induce proinflammatory cytokines in preterm infants. Transfusion 2017; 57:1304-1310. [PMID: 28295397 DOI: 10.1111/trf.14080] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/28/2016] [Accepted: 01/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The risk of developing red blood cell (RBC) transfusion-associated necrotizing enterocolitis (TANEC) in preterm infants has recently been emphasized. Our aim was to assess changes in cytokine serum levels after RBC transfusions in a cohort of very preterm infants to evaluate their possible proinflammatory effect. STUDY DESIGN AND METHODS We carried out a prospective observational study. One transfusion event was studied in infants less than 32 weeks' gestation and more than 7 days old (n = 20) admitted to a tertiary neonatal intensive care unit. Interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α, interferon-γ (IFN-γ), IL-17, monocyte chemoattractant protein-1 (MCP-1), interferon-γ-induced protein 10 (IP-10), intracellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule serum levels were measured in enrolled patients within 120 minutes before (T0 ) the RBC transfusion and then within 120 minutes (T1 ), 12 ± 3 hours (T2 ), 24 ± 6 hours (T3 ), and 48 ± 6 hours (T4 ) after the end of RBC transfusion. RESULTS Infants received 19.8 ± 3.0 mL of RBCs at the mean age of 50 ± 18 days. Their hematocrit level increased from 24.1 ± 1.2% to 39.4 ± 2.9%. IL-1β, IL-8, IFN-γ, IL-17, MCP-1, IP-10, and ICAM-1 increased significantly after RBC transfusions. CONCLUSION Proinflammatory cytokines are increased after RBC transfusion. These findings may contribute to explaining the pathogenesis of TANEC and suggest the opportunity of adopting wise transfusion guidelines that would help to avoid detrimental risks of transfusion-related immunomodulation and of undertransfusion.
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Affiliation(s)
- Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health
| | | | | | | | - Alice Sereni
- Department of Experimental and Clinical Medicine, University of Florence-Atherothrombotic Diseases Centre, Careggi University Hospital of Florence, Florence, Italy
| | - Rosanna Abbate
- Department of Experimental and Clinical Medicine, University of Florence-Atherothrombotic Diseases Centre, Careggi University Hospital of Florence, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence-Atherothrombotic Diseases Centre, Careggi University Hospital of Florence, Florence, Italy
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Hay S, Zupancic JAF, Flannery DD, Kirpalani H, Dukhovny D. Should we believe in transfusion-associated enterocolitis? Applying a GRADE to the literature. Semin Perinatol 2017; 41:80-91. [PMID: 27866662 DOI: 10.1053/j.semperi.2016.09.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Numerous observational studies appear to demonstrate an association between packed red blood cell (pRBC) transfusions and necrotizing enterocolitis (NEC). However, the limited numbers of randomized controlled trials (RCTs) do not support a causal relationship between pRBC transfusion and NEC. We sought to determine the quality of the evidence behind transfusion-associated necrotizing enterocolitis (TANEC), and to formulate a GRADE-based recommendation regarding transfusion practices to reduce the risk of TANEC. A systematic search including MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and clinical trials registries was performed for studies assessing the association between transfusion and NEC. Teams of two paired reviewers independently screened studies for eligibility, assessed risk of bias using the GRADE framework, and collected data from each eligible study. We examined studies for two time points following transfusion: within 48h if this was available, and otherwise at any time after transfusion. In total, 23 observational studies and three RCTs met inclusion criteria. The average rating for the quality of evidence of individual studies was between "very low" and "low." On pooling studies for GRADE review, we observed an inconsistency of results. This led to a final overall quality of "very low" for the evidence for an association between transfusions and necrotizing enterocolitis. The pooled outcome of NEC for observational/case control studies was an odds ratio of 1.13 (95% CI: 0.99-1.29) when TANEC was defined as occurring within 48 hours of transfusion. For NEC occurring at any time post-transfusion, the pooled OR was 1.95 (1.60-2.38). Conversely, the pooled outcome of NEC for the RCT data had an odds ratio of 0.6 (0.3, 1.21) with NEC being less frequent in the liberal transfusion group compared to the restrictive transfusion group. The overall quality of the evidence for TANEC is "very low," suggesting very little confidence in the effect estimate. RCT data tended toward apparent protection against NEC. The available evidence is not sufficient to support a practice recommendation around pRBC transfusions in the context of preventing the development of NEC.
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Affiliation(s)
- Susanne Hay
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA
| | - Dustin D Flannery
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Haresh Kirpalani
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA; Emeritus Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health & Science University, Mail Code CDRC-P, 707 SW Gaines St, Portland, OR 97239.
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D’Souza A, Algotar A, Pan L, Schwarz SM, Treem WR, Valencia G, Rabinowitz SS. Packed red blood cell transfusions as a risk factor for parenteral nutrition associated liver disease in premature infants. World J Clin Pediatr 2016; 5:365-369. [PMID: 27872824 PMCID: PMC5099588 DOI: 10.5409/wjcp.v5.i4.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/13/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease.
METHODS A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell (PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin (db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells (the median value). Kaplan-Meier plots estimated the median volume of packed red blood cells received in order to develop parenteral nutrition associated liver disease.
RESULTS Parenteral nutritional associated liver disease (PNALD) was noted in 21 (43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17 (64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.
CONCLUSION In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.
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Banerjee J, Leung TS, Aladangady N. Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants. Early Hum Dev 2016; 97:1-8. [PMID: 26619762 DOI: 10.1016/j.earlhumdev.2015.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Preterm infants frequently receive blood transfusion (BT) and the aim of this study was to measure the effect of BT on cerebral blood flow and oxygenation in preterm infants in relation to chronological age. PATIENTS Preterm infants undergoing intensive care recruited to three chronological age groups: 1 to 7 (Group 1; n=20), 8 to 28 (Group 2; n=21) & ≥29days of life (Group 3; n=18). METHODS Pre and post-BT anterior cerebral artery (ACA) time averaged mean velocity (TAMV) and superior vena cava (SVC) flow were measured. Cerebral Tissue Haemoglobin Index (cTHI) and Oxygenation Index (cTOI) were measured from 15-20min before to 15-20min post-BT using NIRS. Vital parameters and blood pressure were measured continuously. RESULTS Mean BP increased significantly, and there was no significant change in vital parameters following BT. Pre-BT ACA TAMV was higher in Group 2 and 3 compared to Group 1 (p<0.001). Pre-BT ACA TAMV decreased significantly (p≤0.04) in all 3 groups; pre-BT SVC flow decreased significantly in Group 1 (p=0.03) and Group 3 (p<0.001) following BT. Pre-BT cTOI was significantly lower in Group 3 compared to Group 1 (p=0.02). cTHI (p<0.001) and cTOI (p<0.05) increased significantly post-BT in all three groups. PDA had no effect on these measurements. CONCLUSION Baseline cTOI decreases and ACA TAMV increases with increasing chronological age. Blood transfusion increased cTOI and cTHI and decreased ACA TAMV in all groups. PDA had no impact on the baseline cerebral oximetry and blood flow as well as changes following blood transfusion.
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Affiliation(s)
- J Banerjee
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London E9 6SR, UK; Centre for Genomics and Child Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Portland Hospital, London, UK.
| | - T S Leung
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, UK.
| | - N Aladangady
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London E9 6SR, UK; Centre for Genomics and Child Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Paediatrics, SDM Medical College and Hospitals, Dharwad, India.
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69
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Sayari AJ, Tashiro J, Sola JE, Perez EA. Blood transfusions, increased rates of surgical NEC, and lower survival: a propensity score-matched analysis. J Pediatr Surg 2016; 51:927-31. [PMID: 26995520 DOI: 10.1016/j.jpedsurg.2016.02.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE We sought to investigate the association between blood transfusions (BT), rates of necrotizing enterocolitis requiring surgical intervention (SNEC), and survival. METHODS Blood transfusions in premature infants were identified in the Kids' Inpatient Database (2003-2009). Propensity score-matched analysis compared SNEC outcomes in BT vs. non-BT groups. Multivariate analyses were performed to determine independent predictors of outcome. RESULTS Overall, 663740 cases were identified and 4.9% received BT. Surgical necrotizing enterocolitis occurred in 493 cases in the BT group, while SNEC occurred in 1049 cases in the non-BT group. Propensity score analysis of 20991 BT and 20988 non-BT cases demonstrated higher SNEC rates with BT (odds ratio [OR], 1.21) vs non-BT. Surgical necrotizing enterocolitis with BT had lower survival rates (58%) vs non-BT (67%). Surgical necrotizing enterocolitis with BT had lower length of stay and total charges vs non-BT. On multivariate analyses, SNEC mortality with BT increased for lower gestational age, males (OR, 45.7), African Americans (OR, 64.4), and infants with cardiac anomalies (OR, 50.8) or bronchopulmonary dysplasia (OR, 177). Non-BT SNEC demonstrated higher mortality with lower gestational age and infants with bronchopulmonary dysplasia (OR, 6.56) or sepsis (OR, 3.66). CONCLUSION On propensity score-matched analysis, SNEC occurs at higher rates after BT and is associated with lower survival and lower resource utilization vs SNEC without BT.
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Affiliation(s)
- Arash J Sayari
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
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White JR, Gong H, Colaizy T, Moreland JG, Flaherty H, McElroy SJ. Evaluation of hematologic variables in newborn C57/BL6 mice up to day 35. Vet Clin Pathol 2016; 45:87-95. [PMID: 26717267 PMCID: PMC4805471 DOI: 10.1111/vcp.12314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hematologic variables are often analyzed in animal analogs during the investigation of complex disease etiologies such as necrotizing enterocolitis. However, reference intervals (RI) can vary depending on animal strain, age, and sampling site. Reference intervals have been published for adult C57BL/6J mice, but not newborn C57BL/6J mice. OBJECTIVES The purpose of the present study was to determine hematologic RI in newborn C57BL/6J mice up to day 35. METHODS C57BL/6J mice founders from The Jackson Laboratory were bred at the University of Iowa. Blood samples were obtained via facial vein sampling at postnatal days 0 (p0), p7, p14, p21, p28, or young adulthood (p35). CBCs were determined with the Sysmex XT-2000iV analyzer within 30 minutes of blood collection at a 1:10 dilution. Statistics were determined using nonparametric methods following ASVCP guidelines. RESULTS Hematologic RI were determined for each of the 6 groups (n = 247, n ≥ 39 per group). Significantly higher values for HGB, RBC, and PLT counts were observed with advancing developmental age. Total WBC counts remained relatively stable during the first 35 days of life. However, WBC differential counts were dominated by neutrophils and lymphocytes in the younger mice, with a trend toward a lymphocytic leukogram on day 35. CONCLUSIONS These results illustrate the dynamic changes in hematologic variables during murine development after birth. Utilization of age-specific RI is advised when evaluating data derived from experimental perinatal mouse models.
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Affiliation(s)
| | - Huiyu Gong
- Pediatrics, University of Iowa, Iowa City, IA, USA
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Slidsborg C, Jensen A, Forman JL, Rasmussen S, Bangsgaard R, Fledelius HC, Greisen G, la Cour M. Neonatal Risk Factors for Treatment-Demanding Retinopathy of Prematurity: A Danish National Study. Ophthalmology 2016; 123:796-803. [PMID: 26854038 DOI: 10.1016/j.ophtha.2015.12.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/11/2015] [Accepted: 12/13/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE One goal of the study was to identify "new" statistically independent risk factors for treatment-demanding retinopathy of prematurity (ROP). Another goal was to evaluate whether any new risk factors could explain the increase in the incidence of treatment-demanding ROP over time in Denmark. DESIGN A retrospective, register-based cohort study. PARTICIPANTS The study included premature infants (n = 6490) born in Denmark from 1997 to 2008. METHODS The study sample and the 31 candidate risk factors were identified in 3 national registers. Data were linked through a unique civil registration number. Each of the 31 candidate risk factors were evaluated in univariate analyses, while adjusted for known risk factors (i.e., gestational age [GA] at delivery, small for gestational age [SGA], multiple births, and male sex). Significant outcomes were analyzed thereafter in a backward selection multiple logistic regression model. MAIN OUTCOME MEASURES Treatment-demanding ROP and its associations to candidate risk factors. RESULTS Mechanical ventilation (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.99-4.08; P < 0.01) and blood transfusion (OR, 1.97; 95% CI, 1.20-3.14; P = 0.01) were the only new statistically independent risk factors, in addition to GA at delivery, SGA, multiple births, and male sex. Modification in these prognostic factors for ROP did not cause an increase in treatment-demanding ROP. CONCLUSIONS In a large study population, blood transfusion and mechanical ventilation were the only new statistically independent risk factors to predict the development of treatment-demanding ROP. Modification in the neonatal treatment with mechanical ventilation or blood transfusion did not cause the observed increase in the incidence of preterm infants with treatment-demanding ROP during a recent birth period (2003-2008).
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Affiliation(s)
- Carina Slidsborg
- Department of Ophthalmology, Copenhagen University Hospital, Glostrup Hospital and Rigshospitalet, Denmark.
| | - Aksel Jensen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Julie Lyng Forman
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Steen Rasmussen
- Department of Clinical Microbiology, Hvidovre Hospital, Hvidovre, Denmark
| | - Regitze Bangsgaard
- Department of Ophthalmology, Copenhagen University Hospital, Glostrup Hospital and Rigshospitalet, Denmark
| | - Hans Callø Fledelius
- Department of Ophthalmology, Copenhagen University Hospital, Glostrup Hospital and Rigshospitalet, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Copenhagen University Hospital, Glostrup Hospital and Rigshospitalet, Denmark
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Outcomes of a Quality Improvement Initiative to Prevent Unnecessary Packed Red Blood Cell Transfusions Among Extremely Low Birth-Weight Neonates. Adv Neonatal Care 2016; 16:E3-9. [PMID: 26734813 DOI: 10.1097/anc.0000000000000249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extremely low birth-weight (ELBW) infants frequently receive packed red blood cell (PRBC) transfusions. Recent studies have shown that more restrictive PRBC transfusion guidelines limit donor exposure and reduce transfusion-related costs without any increase in adverse clinical outcomes. PURPOSE We developed and implemented an evidence-based PRBC transfusion guideline for ELBW infants treated in our unit and then measured provider adherence to this guideline. METHODS/SEARCH STRATEGY We performed a retrospective review of all PRBC transfusions given to ELBW infants in 2012 (preguideline) and the first half of 2014 (postguideline). We identified the indication for each transfusion by reviewing physiological/laboratory data and the daily clinical note. We then determine whether each transfusion met criteria according to our new evidence-based guideline. FINDINGS/RESULTS When extrapolating the newly developed protocol to 2012 data, less than 15% of transfusions among ELBW infants would have met the current evidence-based standard. Conversely, during the first 6 months of 2014, 61% of transfusions were administered in adherence to the guideline (P < 001). Using current cost estimates, this represents a projected cost savings of $31,000 in that 6-month period. IMPLICATIONS FOR PRACTICE A multidisciplinary approach to improving PRBC transfusion practices results in potentially safer, more cost-effective care for ELBW infants. IMPLICATIONS FOR RESEARCH Given the frequency, potential harms, and costs associated with PRBC transfusions in ELBW infants, it seems both feasible and important to pursue prospective clinical trials comparing permissive and restrictive approaches to transfusion in this vulnerable population.
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Oñatibia-Astibia A, Martínez-Pinilla E, Franco R. The potential of methylxanthine-based therapies in pediatric respiratory tract diseases. Respir Med 2016; 112:1-9. [PMID: 26880379 DOI: 10.1016/j.rmed.2016.01.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/07/2015] [Accepted: 01/28/2016] [Indexed: 02/03/2023]
Abstract
Caffeine, theophylline and theobromine are the most known methylxanthines as they are present in coffee, tea and/or chocolate. In the last decades, a huge experimental effort has been devoted to get insight into the variety of actions that these compounds exert in humans. From such knowledge it is known that methylxanthines have a great potential in prevention, therapy and/or management of a variety of diseases. The benefits of methylxanthine-based therapies in the apnea of prematurity and their translational potential in pediatric affections of the respiratory tract are here presented.
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Affiliation(s)
| | - Eva Martínez-Pinilla
- Neuroscience Department, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.
| | - Rafael Franco
- Molecular Neurobiology Laboratory, Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; CIBERNED, Centro de Investigación en Red, Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28049 Madrid, Spain; Institute of Biomedicine of the University of Barcelona, IBUB, 08028, Barcelona, Spain.
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74
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Keir AK, Wilkinson D, Andersen C, Stark MJ. Washed versus unwashed red blood cells for transfusion for the prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2016; 2016:CD011484. [PMID: 26788664 PMCID: PMC8733671 DOI: 10.1002/14651858.cd011484.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infants born very preterm often receive multiple red blood cell (RBC) transfusions during their initial hospitalisation. However, there is an increasing awareness of potential adverse effects of RBC transfusions in this vulnerable patient population. Modification of RBCs prior to transfusion, through washing with 0.9% saline, may reduce these adverse effects and reduce the rate of significant morbidity and mortality for preterm infants and improve outcomes for this high-risk group. OBJECTIVES To determine whether pre-transfusion washing of RBCs prevents morbidity and mortality in preterm infants. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE via PubMed (31 July 2015), EMBASE (31 July 2015), and CINAHL (31 July 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised, cluster randomised, and quasi-randomised controlled trials including preterm infants (less than 32 weeks gestation) or very low birth weight infants (less than 1500 g), or both, who received one or more washed packed RBC transfusions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the trials. We identified four studies from the initial search. After further review of the full-text studies, we found one study meeting the selection criteria. MAIN RESULTS We included a single study enrolling a total of 21 infants for analysis in this review and reported on all-cause mortality during hospital stay, length of initial neonatal intensive care unit (NICU) stay (days), and duration of mechanical ventilation (days). There was no significant difference in mortality between the washed versus the unwashed RBCs for transfusion groups (risk ratio 1.63, 95% confidence interval (CI) 0.28 to 9.36; risk difference 0.10, 95% CI -0.26 to 0.45). There was no significant difference in the length of initial NICU stay between the washed versus the unwashed RBCs for transfusion groups (mean difference (MD) 25 days, 95% CI -21.15 to 71.15) or the duration of mechanical ventilation between the washed versus the unwashed RBCs for transfusion groups (MD 9.60 days, 95% CI -1.90 to 21.10). AUTHORS' CONCLUSIONS We identified a single small study. The results from this study show a high level of uncertainty, as the confidence intervals are consistent with both a large improvement or a serious harm caused by the intervention. Consequently, there is insufficient evidence to support or refute the use of washed RBCs to prevent the development of significant neonatal morbidities or mortality. Further clinical trials are required to assess the potential effects of pre-transfusion washing of RBCs for preterm or very low birth weight infants, or both, on short- and long-term outcomes.
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Affiliation(s)
- Amy K Keir
- University of AdelaideRobinson Research Institute72 King William RoadAdelaideAustralia
- Women's and Children's HospitalDepartment of Neonatal Medicine72 King William RoadNorth AdelaideAustralia
| | - Dominic Wilkinson
- University of AdelaideRobinson Research Institute72 King William RoadAdelaideAustralia
- University of OxfordOxford Uehiro Centre for Practical EthicsOxfordUK
| | - Chad Andersen
- University of AdelaideRobinson Research Institute72 King William RoadAdelaideAustralia
- Women's and Children's HospitalDepartment of Neonatal Medicine72 King William RoadNorth AdelaideAustralia
| | - Michael J Stark
- University of AdelaideRobinson Research Institute72 King William RoadAdelaideAustralia
- Women's and Children's HospitalDepartment of Neonatal Medicine72 King William RoadNorth AdelaideAustralia
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Abstract
Apnea of prematurity is one of the most common diagnoses in the NICU. Despite the frequency of apnea of prematurity, it is unknown whether recurrent apnea, bradycardia, and hypoxemia in preterm infants are harmful. Research into the development of respiratory control in immature animals and preterm infants has facilitated our understanding of the pathogenesis and treatment of apnea of prematurity. However, the lack of consistent definitions, monitoring practices, and consensus about clinical significance leads to significant variation in practice. The purpose of this clinical report is to review the evidence basis for the definition, epidemiology, and treatment of apnea of prematurity as well as discharge recommendations for preterm infants diagnosed with recurrent apneic events.
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Lopez E, Beuchée A, Truffert P, Pouvreau N, Patkai J, Baud O, Boubred F, Flamant C, Jarreau PH. L’érythropoïétine humaine recombinante chez le nouveau-né : recommandations pour la pratique clinique de la Société française de néonatologie. Arch Pediatr 2015; 22:1092-7. [DOI: 10.1016/j.arcped.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/03/2015] [Indexed: 02/07/2023]
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Alan S, Arsan S. Prevention of the anaemia of prematurity. Int J Pediatr Adolesc Med 2015; 2:99-106. [PMID: 30805447 PMCID: PMC6372412 DOI: 10.1016/j.ijpam.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
Despite recent advances in neonatal and perinatal medicine, extremely low birth weight infants (ELBW) are at high risk of developing anaemia of prematurity (AOP) requiring packed red blood cell (RBC) transfusions. The benefit of transfusing allogenic RBCs for AOP is a controversial issue, except for disturbances in tissue oxygenation. Although the role of erythropoietin (EPO) in the pathophysiology of AOP is well known, neither early nor late recombinant human EPO therapy alters the number or volume of RBC transfusions. It is also known that one-half of the feto-placental blood volume remains outside the newborn infant's circulation at 30 weeks of gestation if the umbilical cord is clamped immediately. Delayed cord clamping (DCC) and umbilical cord milking (UCM) are the main methods for enhancing placental transfusion. The basic principle of these approaches depends on providing high haemoglobin (Hb) levels to premature infants in the delivery room. The enhancement of placental transfusion clearly results in higher Hb levels at birth, reducing the need for RBC transfusions as well as creating a better haemodynamic status during the initial hours of life. To date, enhancement of placental transfusion in the delivery room by either DCC or UCM seems to be the best preventive measure for AOP. Yet, studies on the associated neurodevelopmental outcomes are insufficient to reach a conclusion. This review summarizes the pathophysiology, treatment and preventative strategies of anaemia of prematurity in light of the current literature.
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Affiliation(s)
- Serdar Alan
- Division of Neonatology, Department of Pediatrics, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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78
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Sood BG, Rambhatla A, Thomas R, Chen X. Decreased hazard of necrotizing enterocolitis in preterm neonates receiving red cell transfusions. J Matern Fetal Neonatal Med 2015; 29:737-44. [PMID: 25731658 DOI: 10.3109/14767058.2015.1016422] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Many observational studies reporting a temporal association between red cell transfusions (RBCTs) and necrotizing enterocolitis (NEC) in preterm infants fail to take into account RBCTs in infants without NEC. The objective of this study was to investigate the association between RBCTs and NEC in an analytical retrospective cohort study with minimization of selection and measurement bias and controlling for clinical covariates. METHODS Inborn preterm infants [23-32 weeks gestational age (GA)] without major congenital anomalies were eligible. Association of RBCT and modified Bell's Stage ≥2A NEC was explored using bivariate analyses and verified using multivariable Cox regression. RESULTS Of 627 eligible infants, 305 neither received RBCT nor developed NEC and 12 developed NEC prior to RBCT. Of 310 infants with RBCT, 27 developed NEC. Compared to infants without NEC, infants with NEC received significantly lower number of RBCTs before diagnosis of NEC (p = 0.000). On multivariable Cox regression controlling for clinical covariates, dichotomous RBCT exposure was associated with 60% reduced hazard for NEC. CONCLUSIONS RBCT exposure was associated with decreased hazards for NEC in preterm infants in this study; factors previously reported to be associated with NEC remained statistically significant predictors.
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Affiliation(s)
- Beena G Sood
- a Division of Neonatal-Perinatal Medicine , Hutzel Women's Hospital & Children's Hospital of Michigan , Detroit , MI , USA .,b Department of Pediatrics , Wayne State University School of Medicine , Detroit , MI , USA , and
| | - Anupama Rambhatla
- b Department of Pediatrics , Wayne State University School of Medicine , Detroit , MI , USA , and
| | - Ronald Thomas
- b Department of Pediatrics , Wayne State University School of Medicine , Detroit , MI , USA , and
| | - Xinguang Chen
- c Departemnt of Epidemiology , College of Public Health & Health Professions, University of Florida , Gainesville , FL , USA
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79
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Bianchi M, Giannantonio C, Spartano S, Fioretti M, Landini A, Molisso A, Tesfagabir GM, Tornesello A, Barbagallo O, Valentini CG, Vento G, Zini G, Romagnoli C, Papacci P, Teofili L. Allogeneic umbilical cord blood red cell concentrates: an innovative blood product for transfusion therapy of preterm infants. Neonatology 2015; 107:81-6. [PMID: 25401961 DOI: 10.1159/000368296] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants often receive blood transfusions early in life. In this setting, umbilical cord blood (UCB) might be safer than adult blood (A) with respect to infectious and immunologic threats. OBJECTIVES To evaluate, as a first objective, the feasibility of fulfilling transfusion needs of preterm infants with allogeneic UCB red blood cell (RBC) concentrates and, as a secondary objective, to assess the safety of allogeneic cord blood transfusions. METHODS At the Neonatal Intensive Care Unit and the UNICATT Cord Blood Bank of 'A. Gemelli' Hospital in Rome, a prospective study was carried out over a 1-year period, enrolling newborns with gestational age ≤30 weeks and/or birth weight ≤1,500 g requiring RBC transfusions within the first 28 days of life. At first transfusion, patients were assigned to receive UCB-RBCs or A-RBCs depending on the availability of ABO-Rh(D)-matched UCB-RBC units. The same regimen (UCB-RBC or A-RBC units) was thereafter maintained, unless ABO-Rh(D)-matched UCB-RBC units were not available. RESULTS Overall, 23 UCB-RBC units were transfused to 9 patients; the requests for UCB-RBC units were met in 45% of patients at the first transfusion and in 78% at the subsequent transfusions. At a median follow-up of 57 days (range 6-219), no acute or delayed transfusion-related adverse events occurred. Hematocrit gain after transfusion and time intervals between transfusions were similar in the UCB-RBC and A-RBC group, as well. CONCLUSIONS Transfusing allogeneic UCB-RBC units in preterm infants appears a feasible and safe approach, although the transfusion needs of our study population were not completely covered. More data are necessary to validate this novel transfusion practice.
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Affiliation(s)
- Maria Bianchi
- UNICATT Cord Blood Bank, 'A. Gemelli' Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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80
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Cox C, Hashem NG, Tebbs J, Bookstaver PB, Iskersky V. Evaluation of caffeine and the development of necrotizing enterocolitis. J Neonatal Perinatal Med 2015; 8:339-347. [PMID: 26757002 DOI: 10.3233/npm-15814059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To test the association between medical or surgical necrotizing enterocolitis (NEC) and caffeine administration in premature infants. STUDY DESIGN This single-center, retrospective study evaluated patients admitted to a level 3 neonatal intensive care unit (NICU) over an 18-month period. All patients were evaluated for factors associated with the development of NEC including exposure to caffeine (dosing and duration), gestational age, birth weight, vasoactive medications and maternal illicit drug use. RESULTS There were 615 subjects included in the study; among these subjects, 7.3% (n = 45) developed NEC (35 subjects receiving caffeine and 10 subjects not receiving caffeine). The administration of caffeine (p = 0.008), birth weight (p = 0.014) and the use of vasopressors (p = 0.033) were associated with the development of NEC. When considering only infants with a birth weight less than 1500 g and less than 32 weeks gestation, the effects of caffeine and vasopressor use remained statistically significant (p = 0.047 and p = 0.045, respectively). The time to development of NEC did not differ statistically between patients receiving caffeine and those not receiving caffeine (p = 0.129). CONCLUSION A potential association between the administration of caffeine and the development of medical or surgical necrotizing enterocolitis in premature infants exists. Further investigation of dose-dependent effects and loading doses is warranted.
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Affiliation(s)
- C Cox
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - N G Hashem
- Lancaster General Health, Lancaster, PA, USA
| | - J Tebbs
- Department of Statistics, University of South Carolina, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - V Iskersky
- Department of Neonatology, Palmetto Health Richland, Columbia, SC, USA
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81
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Wallenstein MB, Arain YH, Birnie KL, Andrews J, Palma JP, Benitz WE, Chock VY. Red blood cell transfusion is not associated with necrotizing enterocolitis: a review of consecutive transfusions in a tertiary neonatal intensive care unit. J Pediatr 2014; 165:678-82. [PMID: 25039042 PMCID: PMC4845907 DOI: 10.1016/j.jpeds.2014.06.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 05/12/2014] [Accepted: 06/04/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the association between red blood cell transfusion and necrotizing enterocolitis (NEC) in a neonatal intensive care unit with liberal transfusion practices. STUDY DESIGN A retrospective cohort study was conducted for all infants weighing <1500 g who received at least 1 packed red blood cell transfusion between January 2008 and June 2013 in a tertiary neonatal intensive care unit. The primary outcome was NEC, defined as Bell stage II or greater. The temporal association of NEC and transfusion was assessed using multivariate Poisson regression. RESULTS The study sample included 414 very low birth weight infants who received 2889 consecutive red blood cell transfusions. Twenty-four infants (5.8%) developed NEC. Four cases of NEC occurred within 48 hours of a previous transfusion event. Using multivariate Poisson regression, we did not find evidence of a temporal association between NEC and transfusion (P = .32). CONCLUSION There was no association between NEC and red blood cell transfusion. Our results differ from previous studies and suggest that the association between NEC and transfusion may be contextual.
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Affiliation(s)
- Matthew B. Wallenstein
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
| | - Yassar H. Arain
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
| | - Krista L. Birnie
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Andrews
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,Division of Transfusion Medicine, Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Jonathan P. Palma
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA,Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - William E. Benitz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
| | - Valerie Y. Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
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82
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Keir A, Pal S, Trivella M, Lieberman L, Callum J, Shehata N, Stanworth S. Adverse effects of small-volume red blood cell transfusions in the neonatal population. Syst Rev 2014; 3:92. [PMID: 25143009 PMCID: PMC4149676 DOI: 10.1186/2046-4053-3-92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse transfusion reactions in the neonatal population are poorly understood and defined. The incidence and pattern of adverse effects due to red blood cell (RBC) transfusion are not well known, and there has been no systematic review of published adverse events. RBC transfusions continue to be linked to the development of morbidities unique to neonates, including chronic lung disease, retinopathy of prematurity, intraventricular haemorrhage and necrotising enterocolitis. Uncertainties about the exact nature of risks alongside benefits of RBC transfusion may contribute to evidence of widespread variation in neonatal RBC transfusion practice.Our review aims to describe clinical adverse effects attributed to small-volume (10-20 mL/kg) RBC transfusions and, where possible, their incidence rates in the neonatal population through the systematic identification of all relevant studies. METHODS A comprehensive search of the following bibliographic databases will be performed: MEDLINE (PubMed/OVID which includes the Cochrane Library) and EMBASE (OVID). The intervention of interest is small-volume (10-20 mL/kg) RBC transfusions in the neonatal population.We will undertake a narrative synthesis of the evidence. If clinical similarity and data quantity and quality permit, we will also carry out meta-analyses on the listed outcomes. DISCUSSION This systematic review will identify and synthesise the reported adverse effects and associations of RBC transfusions in the neonatal population. We believe that this systematic review is timely and will make a valuable contribution to highlight an existing research gap. TRIAL REGISTRATION PROSPERO, CRD42013005107http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005107.
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Affiliation(s)
- Amy Keir
- School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide 5005, Australia
- Department of Neonatal Medicine, Level 1 Queen Victoria Building, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia 5006, Australia
| | - Sanchita Pal
- Rosie Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust Cambridge, Cambridge CB2 0QQ, UK
| | - Marialena Trivella
- Centre for Statistics in Medicine, University of Oxford, Oxford OX2 6UD, UK
| | - Lani Lieberman
- Transfusion Medicine, University Health Network, Toronto M5G 2N2, Canada
- Department of Clinical Pathology, University of Toronto, Toronto M5G 2M9, Canada
| | - Jeannie Callum
- Transfusion Medicine and Tissue Banks, Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M5S 1A1, Canada
| | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M5S 1A1, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto M5G 1X5, Canada
| | - Simon Stanworth
- National Health Service Blood and Transplant/Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK
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83
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Banerjee J, Aladangady N. Biomarkers to decide red blood cell transfusion in newborn infants. Transfusion 2014; 54:2574-82. [DOI: 10.1111/trf.12670] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Jayanta Banerjee
- Homerton University Hospital NHS Foundation Trust; London UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London; London UK
- The Portland Hospital for Women and Children; London UK
| | - Narendra Aladangady
- Homerton University Hospital NHS Foundation Trust; London UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London; London UK
- SDMC Medical School and Hospital; Dharwad India
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84
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Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants. Sci Rep 2014; 4:4340. [PMID: 24614152 PMCID: PMC3949297 DOI: 10.1038/srep04340] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/24/2014] [Indexed: 01/17/2023] Open
Abstract
Anemia and the need for transfusion of packed red blood cells (PRBCs) are common in preterm infants. PRBC transfusion increases the oxygen carrying capacity of hemoglobin and may result in higher rates of organ dysfunction. To determine whether PRBC transfusion in preterm infants is associated with an increased incidence of bronchopulmonary dysplasia (BPD), this retrospective study was performed on neonates with birth weights ≤ 1,500 g or gestational age ≤ 32 weeks admitted from August, 2008 to November, 2013. Infants who received PRBC transfusion before the diagnosis of BPD and those who did not receive PRBC transfusion or received PRBC transfusion after diagnosis of BPD were compared for incidence of BPD and other morbidities. Of 231 preterm infants, 137 received PRBC transfusion before BPD was diagnosed (group 1) and 94 did not (group 2). The incidence of BPD was significantly higher in group 1 than in group 2 (37.2% vs. 2.1%, P < 0.00001). After adjusting for potential risk factors, the adjusted odds ratio for BPD was 9.80 (95% confidence interval, 1.70-56.36; P = 0.01). This study demonstrated an association between PRBC transfusion and BPD in preterm infants. A cautious approach to PRBC transfusion in these infants is warranted.
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Affiliation(s)
- Zhiqun Zhang
- Division of Neonatology, Department of Pediatrics, Hangzhou First People's Hospital, Zhejiang, China
| | - Xianmei Huang
- Department of Pediatrics, Hangzhou First People's Hospital, Zhejiang, China
| | - Hui Lu
- Division of Neonatology, Department of Pediatrics, Hangzhou First People's Hospital, Zhejiang, China
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85
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Polglase GR, Barton SK, Melville JM, Zahra V, Wallace MJ, Siew ML, Tolcos M, Moss TJM. Prophylactic erythropoietin exacerbates ventilation-induced lung inflammation and injury in preterm lambs. J Physiol 2014; 592:1993-2002. [PMID: 24591575 DOI: 10.1113/jphysiol.2013.270348] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ventilation-induced lung injury (VILI) of preterm neonates probably contributes to the pathogenesis of bronchopulmonary dysplasia (BPD). Erythropoietin (EPO) has been suggested as a therapy for BPD. The aim of this study was to determine whether prophylactic administration of EPO reduces VILI in preterm newborn lambs. Lambs at 126 days of gestation (term is 147 days) were delivered and ventilated with a high tidal volume strategy for 15 min to cause lung injury, then received gentle ventilation until 2 h of age. Lambs were randomized to receive intravenous EPO (5000 IU kg(-1): Vent+EPO; n = 6) or phosphate-buffered saline (Vent; n = 7) soon after birth: unventilated controls (UVC; n = 8) did not receive ventilation or any treatment. Physiological parameters were recorded throughout the experimental procedure. Samples of lung were collected for histological and molecular assessment of inflammation and injury. Samples of liver were collected to assess the systemic acute phase response. Vent+EPO lambs received higher F IO 2, P aO 2 and oxygenation during the first 10 min than Vent lambs. There were no differences in physiological indices beyond this time. Total lung injury score, airway wall thickness, inflammation and haemorrhage were higher in Vent+EPO lambs than in Vent lambs. Lung inflammation and early markers of lung and systemic injury were elevated in ventilated lambs relative to unventilated lambs; EPO administration further increased lung inflammation and markers of lung and systemic injury. Prophylactic EPO exacerbates VILI, which may increase the incidence and severity of long-term respiratory disease. More studies are required before EPO can be used for lung protection in preterm infants.
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Affiliation(s)
- Graeme R Polglase
- Ritchie Centre, Monash Institute of Medical Research, PO Box 5418, Clayton, Victoria, 3168, Australia.
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86
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Ibrahim M, Ho SKY, Yeo CL. Restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants: a systematic review and meta-analysis. J Paediatr Child Health 2014; 50:122-30. [PMID: 24118127 DOI: 10.1111/jpc.12409] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 12/15/2022]
Abstract
AIM A systematic review was conducted to examine the effects of restrictive versus liberal red blood cell (RBC) transfusion thresholds on clinically important outcomes in very low birth weight (VLBW) infants. METHODS Randomised controlled trials (RCTs) of varying RBC transfusion thresholds in VLBW infants were identified by searching MEDLINE, EMBASE, CINAHL, all of the Cochrane Library and other supplementary sources. Selected studies included one of the following outcomes: total number of red blood cell transfusions, donor exposure rate, cranial ultrasonographically diagnosed brain injury, retinopathy of prematurity, bronchopulmonary dysplasia, necrotising enterocolitis or death. Studies to be included were selected by two reviewers who also assessed the risk of bias of each trial. Data extraction and analyses were independently performed by two reviewers. All data were analysed using RevMan 5. RESULTS Six RCTs were identified. One trial did not meet the inclusion criteria, while two had inadequate methodological quality. Pooled analysis of two trials showed that the restrictive transfusion group received a significantly lower mean number of transfusions per infant (mean difference (MD) -1.35, 95% confidence interval (CI) [-2.61, -0.09]) and donor exposure rate (MD -0.54, 95% CI [-0.93, -0.15]). No other statistically significant differences were observed. CONCLUSION Restrictive RBC transfusion thresholds in VLBW infants may be utilised without incurring clinically important increases in the risk of death or major short-term neonatal morbidities.
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Affiliation(s)
- Masitah Ibrahim
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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87
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Christensen RD, Carroll PD, Josephson CD. Evidence-based advances in transfusion practice in neonatal intensive care units. Neonatology 2014; 106:245-53. [PMID: 25300949 DOI: 10.1159/000365135] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transfusions to neonates convey both benefits and risks, and evidence is needed to guide wise use. Such evidence is accumulating, but more information is needed to generate sound evidence-based practices. OBJECTIVE We sought to analyze published information on nine aspects of transfusion practice in neonatal intensive care units. METHODS We assigned 'categories of evidence' and 'recommendations' using the format of the United States Preventive Services Task Force of the Agency for Healthcare Research and Quality. RESULTS The nine practices studied were: (1) delayed clamping or milking of the umbilical cord at preterm delivery - recommended, high/substantial A; (2) drawing the initial blood tests from cord/placental blood from very low birth weight (VLBW, <1,500 g) infants at delivery - recommended, moderate/moderate B; (3) limiting phlebotomy losses of VLBW infants - recommended, moderate/substantial B; (4) selected use of erythropoiesis-stimulating agents to prevent transfusions - recommended, moderate/moderate-moderate/small B, C; (5) using platelet mass, rather than platelet count, in platelet transfusion decisions - recommended, moderate/small C; (6) permitting the platelet count to fall to <20,000/µl in 'stable' neonates before transfusing platelets - recommended, low/small I; (8) permitting the platelet count to fall to <50,000/µl in 'unstable' neonates before transfusing platelets - recommended, moderate/small C, and (9) not performing routine coagulation test screening on every VLBW infant - recommended, moderate/small C. CONCLUSIONS We view these recommendations as dynamic, to be revised as additional evidence becomes available. We predict this list will expand as new studies provide more information to guide best transfusion practices.
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88
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Affiliation(s)
- Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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89
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Nair J, Gugino SF, Nielsen LC, Allen C, Russell JA, Mathew B, Swartz DD, Lakshminrusimha S. Packed red cell transfusions alter mesenteric arterial reactivity and nitric oxide pathway in preterm lambs. Pediatr Res 2013; 74:652-7. [PMID: 24002328 PMCID: PMC4401459 DOI: 10.1038/pr.2013.153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/23/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cases of necrotizing enterocolitis occurring within 48 h of packed red blood cell (PRBC) transfusions are increasingly being described in observational studies. Transfusion-associated gut injury is speculated to result from an abnormal mesenteric vascular response to transfusion. However, the mechanism of disruption of the balance between mesenteric vasoconstriction and relaxation following transfusion is not known. METHODS Preterm lambs (n = 16, 134 d gestation; term: 145-147 d) were delivered and ventilated for 24 h. All the lambs received orogastric feeds with colostrum. In addition, 10 of these lambs received PRBC transfusions. Vasoreactivity was evaluated in isolated mesenteric arterial rings using norepinephrine and endothelin-1 as vasoconstrictors. Endothelium-dependent (A23187, a calcium ionophore) and endothelium-independent (SNAP) nitric oxide (NO) donors were used as vasorelaxants. Mesenteric arterial endothelial NO synthase (eNOS), soluble guanylyl cyclase (sGC), and phosphodiesterase 5 (PDE5) mRNA analyses and protein assays were performed. RESULTS Transfusion with PRBC significantly increased mesenteric vasoconstriction to norepinephrine and endothelin-1 and impaired relaxation to A23187 and SNAP. Mesenteric arterial eNOS protein decreased following PRBC transfusion. No significant changes were noted in sGC and PDE5 mRNA or protein assays. CONCLUSION PRBC transfusion in enterally fed preterm lambs promotes mesenteric vasoconstriction and impairs vasorelaxation by reducing mesenteric arterial eNOS.
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Affiliation(s)
- Jayasree Nair
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York
| | - Sylvia F. Gugino
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York
| | - Lori C. Nielsen
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York
| | - Cheryl Allen
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York
| | - James A. Russell
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York,Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, New York
| | - Bobby Mathew
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York
| | - Daniel D. Swartz
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York
| | - Satyan Lakshminrusimha
- Department of Pediatrics, Division of Neonatology, State University of New York at Buffalo, Buffalo, New York
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90
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Stark MJ, Keir AK, Andersen CC. Does non-transferrin bound iron contribute to transfusion related immune-modulation in preterms? Arch Dis Child Fetal Neonatal Ed 2013; 98:F424-9. [PMID: 23475935 DOI: 10.1136/archdischild-2012-303353] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There is increasing awareness that allogeneic transfusion is potentially harmful in preterm neonates secondary to transfusion related immunomodulation (TRIM). Non-transferrin bound iron (NTBI) may contribute to TRIM by promoting oxidative damage and pro-inflammatory cytokine release. The current study aimed to determine if transfusion early in the neonatal period resulted in an increase in circulating NTBI, oxidative stress and immune activation. DESIGN Prospective observational study. SETTING One transfusion event was studied in infants ≤28 weeks gestation between 2 and 6 weeks postnatal age (n=33) admitted to a tertiary neonatal intensive care unit. METHODS Serum NTBI, inflammatory cytokines and malondialdehyde (MDA) were measured from the donor pack, prior to and at 2-4 and 24 h post-transfusion. RESULTS Median (range) age at transfusion was 17 (14-39) days with the pretransfusion haemoglobin level 9.6 (7.4-10.4) g/dl. NTBI was detectable in 18 (51%) of the transfusion packs. NTBI levels were higher after transfusion (p<0.01) returning to pretransfusion levels by 24 h. Post-transfusion NTBI level correlated with the age of transfused blood (p<0.001) and was positively correlated with plasma MDA (p=0.01) but not IL-1β, IL-6, IL8 or TNFα. CONCLUSIONS Circulating NTBI is transiently elevated following blood transfusion in preterm newborns. This increase was related to the age of blood transfused and correlated with increases in oxidative stress but not pro-inflammatory cytokines. While further studies are necessary to determine whether these transient effects influence clinical outcome, the current data do not support a significant role in the very preterm neonate for NTBI in TRIM.
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Affiliation(s)
- Michael J Stark
- Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.
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91
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Gehrie E, Keiser A, Dawling S, Travis J, Strathmann F, Booth GS. Primary prevention of pediatric lead exposure requires new approaches to transfusion screening. J Pediatr 2013; 163:855-9. [PMID: 23582137 PMCID: PMC4795168 DOI: 10.1016/j.jpeds.2013.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/22/2013] [Accepted: 03/04/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To facilitate further assessment of transfusion-associated lead exposure by designing a procedure to test packed red blood cells (pRBCs) prepared for transfusion. STUDY DESIGN The relationship between pRBCs and whole blood lead concentration was investigated in 27 samples using a modified clinical assay. Lead concentrations were measured in 100 pRBC units. RESULTS Our sample preparation method demonstrated a correlation between whole blood lead and pRBC lead concentrations (R(2) = 0.82). In addition, all 100 pRBC units tested had detectable lead levels. The median pRBC lead concentration was 0.8 μg/dL, with an SD of 0.8 μg/dL and a range of 0.2-4.1 μg/dL. In addition, after only a few days of storage, approximately 25% of whole blood lead was found in the supernatant plasma. CONCLUSION Transfusion of pRBCs is a source of lead exposure. Here we report the quantification of lead concentration in pRBCs. We found a >20-fold range of lead concentrations in the samples tested. Pretransfusion testing of pRBC units according to our proposed approach or donor screening of whole blood lead and selection of below-average units for transfusion to children would diminish an easily overlooked source of pediatric lead exposure.
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Affiliation(s)
- Eric Gehrie
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Amaris Keiser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sheila Dawling
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - James Travis
- ARUP Institute for Clinical and Experimental Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Frederick Strathmann
- ARUP Institute for Clinical and Experimental Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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92
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Abstract
BACKGROUND This study aims to investigate the incidence and the relative risk factors of retinopathy of prematurity (ROP) and posterior-ROP (P-ROP): ROP in Zone I and posterior Zone II, as well as to analyze the occurrence of surgical treatment of ROP and to evaluate the short term outcome of the disease in Italy. METHODS It is a prospective multicenter observational study; all infants with a birth weight (BW) ≤ 750 g and/or a gestational age (GA) ≤27 weeks born between January 1st 2008 and December 31st 2009 in 25 III level Italian neonatal intensive care units were eligible for the study. RESULTS 421 infants were examined: 265 (62.9%) developed ROP and 102 (24.2%) P-ROP. CONCLUSIONS P-ROP is the most aggressive type of ROP. It associates with lower GA and sepsis. Obstetricians and Neonatologists must focus on the reduction of severe preterm births and on the prevention of neonatal early and late onset sepsis in order to reduce the incidence of P-ROP.
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93
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Luton A. Transfusion-associated necrotizing enterocolitis: translating knowledge into nursing practice. Neonatal Netw 2013; 32:167-174. [PMID: 23666186 DOI: 10.1891/0730-0832.32.3.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Necrotizing enterocolitis (NEC) is a leading cause of prolonged hospitalizations for premature infants in the United States. In a recent large retrospective study, a significant proportion of NEC cases were shown to occur within 48 hours of packed red blood cell (PRBC) transfusion, especially in growing preterm neonates of older postnatal age. A small body of evidence consistently demonstrates that 25-35 percent of NEC cases are temporally associated with PRBC transfusion and that cases of NEC associated with transfusion are generally more severe with a higher rate of surgical intervention and mortality. Awareness of this association is vital for potential prevention and early recognition of NEC. The neonatal nurse has a primary role in care strategies that may affect NEC. This review of literature was compiled to educate neonatal nurses about the existence of transfusion-associated necrotizing enterocolitis and guide the translation of knowledge into nursing practice at the bedside.
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94
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Lampkin SJ, Turner AM, Lakshminrusimha S, Mathew B, Brown J, Fominaya CE, Johnson KK. Association between caffeine citrate exposure and necrotizing enterocolitis in preterm infants. Am J Health Syst Pharm 2013; 70:603-8. [DOI: 10.2146/ajhp120457] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Stacie J. Lampkin
- Department of Pharmacy Practice, School of Pharmacy, D’Youville College, Buffalo, NY
| | | | - Satyan Lakshminrusimha
- School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York (SUNY), and Chief, Division of Neonatology, WCHB
| | - Bobby Mathew
- School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, and Division of Neonatology, WCHB
| | - Jack Brown
- Medicine and Public Health, University at Buffalo, SUNY, Research Assistant Professor, School of Medicine, University of Rochester, Rochester, NY, and Infectious Disease Specialist, University of Rochester Medical Center
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95
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Khodabux CM, van Hensbergen Y, Slot MC, Bakker-Verweij M, Giordano PC, Brand A. Exploring the use of expanded erythroid cells for autologous transfusion for anemia of prematurity. Transfusion 2013; 53:3230-9. [PMID: 23521158 DOI: 10.1111/trf.12169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 01/13/2013] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Autologous cord blood (CB) red blood cells (RBCs) can partly substitute transfusion needs in premature infants suffering from anemia. To explore whether expanded CB cells could provide additional autologous cells suitable for transfusion, we set up a simple one-step protocol to expand premature CB cells. STUDY DESIGN AND METHODS CB buffy coat cells and isolated CD34-positive (CD34(pos) ) cells from premature and full-term CB and adult blood were tested with several combinations of growth factors while omitting xenogeneic proteins from the culture medium. Cell differentiation was analyzed serially during 21 days using flow cytometry, progenitor assays, and high-performance liquid chromatography. RESULTS Expanded CB buffy coat cells resulted in a threefold higher number of erythroblasts than the isolated CD34(pos) cells. However, the RBCs contaminating the buffy coat remained present during the culture with uncertain quality. Premature and full-term CB CD34(pos) cells had similar fold expansion capacity and erythroid differentiation. With the use of interleukin-3, stem cell factor, and erythropoietin, the fold increases of all CD34(pos) cell sources were similar: CB 3942 ± 1554, adult peripheral mobilized blood 4702 ± 1826, and bone marrow (BM) 4143 ± 1908. The proportion of CD235a expression indicating erythroblast presence on Day 21 was slightly higher in the adult CD34(pos) cell sources: peripheral blood stem cells (96.7 ± 0.8%) and BM (98.9 ± 0.5%) compared to CB (87.7 ± 2.7%; p = 0.002). We were not able to induce further erythroid maturation in vitro. CONCLUSION This explorative study showed that fairly pure autologous erythroid-expanded cell populations could be obtained by a simple culture method, which should be optimized. Future challenges comprise obtaining ex vivo enucleation of RBCs with the use of a minimal manipulating approach, which can add up to autologous RBCs derived from CB in the treatment of anemia of prematurity.
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Affiliation(s)
- Chantal M Khodabux
- Department of Research, Sanquin Blood Bank, Leiden; Department of Immuno-Hematology and Blood Transfusion, Leiden University Medical Center, Leiden, The, Netherlands; Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The, Netherlands
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96
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Abstract
OBJECTIVE To review causes of anemia in preterm infants and to suggest potential preventive measures. METHODS Data for this review is obtained from review of the literature. RESULTS An approach to investigating and treating causes of neonatal anemia is outlined. CONCLUSIONS Clinical practices can significantly impact anemia in premature infants. Delayed cord clamping, decreasing phlebotomy loss and optimizing nutritional support are practices that may decrease the severity of anemia, thereby decreasing the need for transfusions or erythropoietin treatment.
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Affiliation(s)
- Sandra Juul
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA 98195-6320, USA.
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97
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Affiliation(s)
- Sandra Juul
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA 98195, USA.
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98
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Saleh MI, Nalbant D, Widness JA, Veng-Pedersen P. Population pharmacodynamic analysis of erythropoiesis in preterm infants for determining the anemia treatment potential of erythropoietin. Am J Physiol Regul Integr Comp Physiol 2013; 304:R772-81. [PMID: 23485870 DOI: 10.1152/ajpregu.00173.2012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A population pharmacokinetics/pharmacodynamic (PK/PD) model was developed to describe changes in erythropoiesis as a function of plasma erythropoietin (EPO) concentration over the first 30 days of life in preterm infants who developed severe anemia requiring red blood cell (RBC) transfusion. Several covariates were tested as possible factors influencing the responsiveness to EPO. Discarded blood samples in 27 ventilated preterm infants born at 24-29 wk of gestation were used to construct plasma EPO, hemoglobin (Hb), and RBC concentration-time profiles. The amount of Hb removed for laboratory testing and that transfused throughout the study period were recorded. A population PK/PD model accounting for the dynamic Hb changes experienced by these infants was simultaneously fitted to plasma EPO, Hb, and RBC concentrations. A covariate analysis suggested that the erythropoietic efficacy of EPO is increased for preterm infants at later gestational ages. The PD analysis showed a sevenfold difference in maximum Hb production rate dependent on gestational age and indicated that preterm infants, when stimulated by EPO, have the capacity to produce additional Hb that may result in a decrease in RBC transfusions. The present model has utility in clinical trial simulations investigating the treatment potential of erythropoietic stimulating agents in the treatment of anemia of prematurity.
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Affiliation(s)
- Mohammad I Saleh
- Division of Pharmaceutics, College of Pharmacy, The University of Iowa, Iowa City, IA 52212, USA
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99
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Abstract
PURPOSE Anemia of prematurity is frequent in preterm infants, for which red blood cell (RBC) transfusion remains the treatment of choice. In this study, we attempted to evaluate the characteristics and risk factors of anemia of prematurity, and suggest ways to reduce anemia and the need for multiple transfusions. MATERIALS AND METHODS Preterm infants weighing less than 1500 g (May 2008-May 2009) were divided into two groups depending on whether they received RBC transfusions (transfusion group and non transfusion group). Hemoglobin (Hb) concentration, phlebotomy blood loss, and the amount of RBC transfusion were analyzed. Risk factors of anemia and RBC transfusions were analyzed. RESULTS Fifty infants that survived were enrolled in the present study: 39 in the transfusion group and 11 in the non transfusion group. Hb concentrations gradually decreased by eight weeks. In the transfusion group, gestational age and birth weight were smaller, bronchopulmonary dysplasia and sepsis were more frequent, full feeding was delayed, parenteral nutrition and days spent in the hospital were prolonged, and phlebotomy blood loss was greater than that in the non transfusion group. CONCLUSION Anemia of prematurity was correlated with increased laboratory blood loss, decreased birth weight, prolonged parenteral nutrition, and delayed body weight gain. Accordingly, reducing laboratory phlebotomy loss and parenteral nutrition, as well as improving body weight gain, may be beneficial to infants with anemia of prematurity.
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Affiliation(s)
- Ga Won Jeon
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Beom Sin
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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100
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Keir AK, McPhee AJ, Andersen CC, Stark MJ. Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant. Pediatr Res 2013; 73:75-9. [PMID: 23095979 DOI: 10.1038/pr.2012.144] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transfusion of packed red blood cells (PRBCs) saves lives in the neonatal critical care setting and is one of the most common interventions in the preterm infant. The number and volume of PRBC transfusions are associated with several major neonatal morbidities, although a direct causal link between transfusion and major neonatal morbidity is still to be proven. Transfusion-related immunomodulation (TRIM) may underlie these adverse outcomes, yet it has received little attention in the high-risk preterm infant. METHODS One transfusion event was studied in infants ≤28 wk gestation between 2 and 6 wk postnatal age (n = 28). Plasma inflammatory cytokines and markers of endothelial activation were measured in the infants before and 2-4 h after transfusion, as well as in the donor pack. RESULTS Median (range) age at transfusion was 18 (14-39) days with the pretransfusion hemoglobin level at 9.8 (7.4-10.2) g/dl. Interleukin (IL)-1β (P = 0.01), IL-8 (P = <0.001), tumor necrosis factor-α (P = 0.008), and monocyte chemoattractant protein (P = 0.01) were increased after transfusion. A similar elevation in markers of endothelial activation was seen after transfusion with increased plasma macrophage inhibitory factor (P = 0.005) and soluble intracellular adhesion molecule-1 (P = <0.001). CONCLUSION Production of inflammatory cytokines and immunoactivation of the endothelium observed after the transfusion of PRBCs in the preterm infant may be a manifestation of TRIM. The implications of this emerging phenomenon within the preterm neonatal population warrant further investigation.
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Affiliation(s)
- Amy K Keir
- Department of Neonatal Medicine, Women's and Children's Hospital, South Australia, Australia
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