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Teofili L, Papacci P, Dani C, Cresi F, Remaschi G, Pellegrino C, Bianchi M, Ansaldi G, Campagnoli MF, Vania B, Lepore D, Franco FGS, Fabbri M, de Vera d' Aragona RP, Molisso A, Beccastrini E, Dragonetti A, Orazi L, Pasciuto T, Mozzetta I, Baldascino A, Locatelli E, Valentini CG, Giannantonio C, Carducci B, Gabbriellini S, Albiani R, Ciabatti E, Nicolotti N, Baroni S, Mazzoni A, Besso FG, Serrao F, Purcaro V, Coscia A, Pizzolo R, Raffaeli G, Villa S, Mondello I, Trimarchi A, Beccia F, Ghirardello S, Vento G. Cord blood transfusions in extremely low gestational age neonates to reduce severe retinopathy of prematurity: results of a prespecified interim analysis of the randomized BORN trial. Ital J Pediatr 2024; 50:142. [PMID: 39113069 PMCID: PMC11305044 DOI: 10.1186/s13052-024-01714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Preterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels predict ROP. It is unknown if preventing the HbF decrease also reduces ROP. METHODS BORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of adult donor-RBC units (A-RBCs) reduces the incidence of severe ROP (NCT05100212). Neonates born between 24 and 27 + 6 weeks of gestation are enrolled and randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. Primary outcome is the rate of severe ROP at 40 weeks of PMA or discharge, with a sample size of 146 patients. A prespecified interim analysis was scheduled after the first 58 patients were enrolled, with the main purpose to evaluate the safety of CB-RBC transfusions. RESULTS Results in the intention-to-treat and per-protocol analysis are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBCs or A-RBCs. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06-2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrement before 30 weeks PMA is critical for severe ROP development. Subsequent CB-RBC transfusions do not lessen the ROP risk. CONCLUSIONS The interim analysis shows that CB-RBC transfusion strategy in preterm neonates is safe and, if early adopted, might protect them from severe ROP. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov on October 29, 2021. Identifier number NCT05100212.
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Affiliation(s)
- Luciana Teofili
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy.
- Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Patrizia Papacci
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Dani
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Francesco Cresi
- Città della Salute e della Scienza, Torino, Italy
- Department of Public Health and Pediatrics, Università di Torino, Torino, Italy
| | | | - Claudio Pellegrino
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Bianchi
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | | | | | | | - Domenico Lepore
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Marco Fabbri
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Anna Molisso
- Ospedale Evangelico Villa Betania, Napoli, Italy
| | | | | | - Lorenzo Orazi
- Polo Nazionale Ipovisione IAPB Italia Onlus, Roma, Italy
| | - Tina Pasciuto
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Iolanda Mozzetta
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Antonio Baldascino
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | | | | | - Carmen Giannantonio
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Brigida Carducci
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | | | | | | | - Nicola Nicolotti
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Silvia Baroni
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Francesca Serrao
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Velia Purcaro
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
| | - Alessandra Coscia
- Città della Salute e della Scienza, Torino, Italy
- Department of Public Health and Pediatrics, Università di Torino, Torino, Italy
| | | | - Genny Raffaeli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy
| | - Stefania Villa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Isabella Mondello
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Alfonso Trimarchi
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Flavia Beccia
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Giovanni Vento
- Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Henriksson HB, Hellström A, Nilsson AK, Sjöbom U, Jönsson B, Frändberg S. Bacterial species in cord blood and their significance in the context of clinical use. Transfus Apher Sci 2024; 63:103961. [PMID: 38981148 DOI: 10.1016/j.transci.2024.103961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024]
Abstract
Approximately 90 % of infants born before 28 full weeks(extremely-preterm-infants) receive erythrocyte transfusions in early life. Umbilical cord blood(UCB) has been investigated as an alternative source for erythrocyte transfusions to preterm neonates. This retrospective study aimed to compile/evaluate spectrum of bacteria groups/species intermittently detected in processed UCB at National-Swedish-Cord blood bank, (NS-CBB) during the years 2008-2020. Consecutive data from the years 2008-2020 were investigated. UCB from healthy newborns born after 37 full weeks of gestation was collected following clamping of cord (1 min) through cannulation of umbilical vein(vaginal-and C-section-deliveries). In total, 5194 cord blood units (UCBUs) that met NS-CBB-guidelines for total nucleated-cell-content(TNC) were manufactured from 8875 collections. Of 5194 UCBUs,77,6 % were from vaginal-and 22,4 % from C-section deliveries.Samples(10 mL) were collected from surplus eryhtrocyte fraction post-processing(n = 5194), transferred into BACT/ALERT® aerobic/anaerobic culture flasks and monitored 10 days using BACT/ALERT®-3D-Microbial-Detection-Systems. Positive samples were subcultured and typed for bacterial groups and/or species. Out of 5194 processed sampled UCB units,186 (3,6 %) were discarded due to positive sterility tests, 92 % were detected in samples from vaginal-deliveries and 8 % from C-section-deliveries. In all,16 different groups of bacteria and 27 species were identified. Common bacterial/groups and species were anaerobe gram-negative rods(n = 28),coagulase-negative-staphylococci(n = 21),gram-positive rods(n = 21),anaerobe-gram-positive cocci(n = 20) and viridans-streptococci(n = 13). Extracted from these results,in positive samples(n = 13) from C-section deliveries, bacteria were found:viridans-streptococci(n = 7),Aerococcus-urinae(n = 1), Staphylococcus lugdunensis(n = 1),other coagulase-negative staphylococci(n = 1) or a mix of aerobic/anaerobic bacteria(n = 3). Our results are in alignment with previously published contamination rates in processed UCBUs. Still, results point towards importance of strict microbial monitoring when manufacturing UCBUs to achieve patient-safe- products for stem-cell transplantation/transfusion.
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Affiliation(s)
- Helena Barreto Henriksson
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Research, Development, Education and Innovation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders K Nilsson
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Sjöbom
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Learning and Leadership for Health Care Professionals at the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bodil Jönsson
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofia Frändberg
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Hellström A, Smith LEH, Hård AL. ROP: 80 Years after Its Detection - Where Do We Stand and How Long Will We Continue to Laser? Neonatology 2024; 121:608-615. [PMID: 38776885 PMCID: PMC11446300 DOI: 10.1159/000538907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Retinopathy of prematurity (ROP), a potentially blinding disease, is increasing worldwide because of the increased survival of extremely preterm and preterm infants born where oxygen monitoring and ROP screening programs are insufficient. Repeated retinal examinations are stressful for infants, and laser photocoagulation treatment for sight-threatening ROP is destructive. The use of anti-VEGF agents instead of lasers is widespread but requires a long-term follow-up because of late recurrence of the disease. In addition, the optimal anti-VEGF agent dosage and long-term systemic effects require further study. SUMMARY Interventions preventing ROP would be far preferable, and systemic interventions might promote better development of the brain and other organs. Interventions such as improved oxygen control, provision of fresh maternal milk, supplementation with arachidonic acid and docosahexaenoic acid, and fetal hemoglobin preservation by reducing blood sample volumes may help prevent ROP and reduce the need for treatment. Free readily available online tools to predict severe ROP may reduce unnecessary eye examinations and select, for screening, those at a high risk of needing treatment. KEY MESSAGES Treatment warranting ROP is a sign of impaired neurovascular development in the central nervous system. Preventative measures to improve the outcomes are available. Screening can be refined using tools that can predict severe ROP. Laser treatment and anti-VEGF agents are valuable treatment modalities that may complement each other in recurrent ROP.
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Affiliation(s)
- Ann Hellström
- Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lois E H Smith
- The Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna-Lena Hård
- Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
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Mohammad K, Molloy E, Scher M. Training in neonatal neurocritical care: A case-based interdisciplinary approach. Semin Fetal Neonatal Med 2024:101530. [PMID: 38670881 DOI: 10.1016/j.siny.2024.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Interdisciplinary fetal-neonatal neurology (FNN) training strengthens neonatal neurocritical care (NNCC) clinical decisions. Neonatal neurological phenotypes require immediate followed by sustained neuroprotective care path choices through discharge. Serial assessments during neonatal intensive care unit (NICU) rounds are supplemented by family conferences and didactic interactions. These encounters collectively contribute to optimal interventions yielding more accurate outcome predictions. Maternal-placental-fetal (MPF) triad disease pathways influence postnatal medical complications which potentially reduce effective interventions and negatively impact outcome. The science of uncertainty regarding each neonate's clinical status must consider timing and etiologies that are responsible for fetal and neonatal brain disorders. Shared clinical decisions among all stakeholders' balance "fast" (heuristic) and "slow" (analytic) thinking as more information is assessed regarding etiopathogenetic effects that impair the developmental neuroplasticity process. Two case vignettes stress the importance of FNN perspectives during NNCC that integrates this dual cognitive approach. Clinical care paths evaluations are discussed for an encephalopathic extremely preterm and full-term newborn. Recognition of cognitive errors followed by debiasing strategies can improve clinical decisions during NICU care. Re-evaluations with serial assessments of examination, imaging, placental-cord, and metabolic-genetic information improve clinical decisions that maintain accuracy for interventions and outcome predictions. Discharge planning includes shared decisions among all stakeholders when coordinating primary care, pediatric subspecialty, and early intervention participation. Prioritizing social determinants of healthcare during FNN training strengthens equitable career long NNCC clinical practice, education, and research goals. These perspectives contribute to a life course brain health capital strategy that will benefit all persons across each and successive lifespans.
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Affiliation(s)
| | | | - Mark Scher
- Pediatrics/Neurology, Case Western Reserve University, Cleveland, USA.
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Glaser K, Härtel C, Dammann O, Herting E, Andres O, Speer CP, Göpel W, Stahl A. Response to the Letter to the Editor "Erythrocyte transfusions and retinopathy of prematurity: Plea for application of the two-phase theory" by Emrani et al., 2023. Acta Paediatr 2024; 113:617-618. [PMID: 38129343 DOI: 10.1111/apa.17081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Kirsten Glaser
- Division of Neonatology, Department of Women's and Children's Health, University of Leipzig Medical Center, Leipzig, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
- Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Egbert Herting
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Oliver Andres
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Christian P Speer
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
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