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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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Christensen RD, Bahr TM, Christensen TR, Ohls RK, Krong J, Carlton LC, Henry E, Sheffield MJ, Gerday E, Ilstrup SJ, Kelley WE. Banked term umbilical cord blood to meet the packed red blood cell transfusion needs of extremely-low-gestational-age neonates: a feasibility analysis. J Perinatol 2024; 44:873-879. [PMID: 38030793 DOI: 10.1038/s41372-023-01833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To assess the feasibility of drawing, processing, safety-testing, and banking term umbilical cord blood to meet the packed red blood cell transfusion (RBC Tx) needs of extremely-low-gestational-age neonates (ELGANs). DESIGN (1) Retrospectively analyze all ELGANs RBC Tx over the past three years, (2) Estimate local cord blood availability, (3) Assess interest in this project, and implementation barriers, through stakeholder surveys. RESULTS In three years we cared for 266 ELGANs; 165 (62%) received ≥1 RBC Tx. Annual RBC Tx averaged 197 (95% CI, 152-243). If 10% of our 10,353 annual term births had cord blood drawn and processed, and half of those tested were acceptable for Tx, collections would exceed the 95th % upper estimate for need by >four-fold. Interest exceeded 97%. Identified barriers included FDA approval, training to collect cord blood, and cost. CONCLUSION RBC Tx needs of ELGANS could be met by local cord blood collection.
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Affiliation(s)
- Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA.
- Clinical Research, Intermountain Health, Murray, UT, USA.
| | - Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | | | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jake Krong
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | - Lindsey C Carlton
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | - Erick Henry
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Mark J Sheffield
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Erick Gerday
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Sarah J Ilstrup
- Transfusion Services and Department of Pathology, Intermountain Health, Murray, UT, USA
| | - Walter E Kelley
- American National Red Cross, Salt Lake City, UT, USA
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
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Spencer BL, Fallon BP, McLeod JS, Cornell M, Perrone EE, Manthei DM, Rojas-Peña A, Hirschl RB, Bartlett RH, Mychaliska GB. The role of fetal hemoglobin in the artificial placenta: A premature ovine model. Perfusion 2024:2676591241240725. [PMID: 38519444 DOI: 10.1177/02676591241240725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
INTRODUCTION A radical paradigm shift in the treatment of premature infants failing conventional treatment is to recreate fetal physiology using an extracorporeal Artificial Placenta (AP). The aim of this study is to evaluate the effects of changing fetal hemoglobin percent (HbF%) on physiology and circuit function during AP support in an ovine model. METHODS Extremely premature lambs (n = 5) were delivered by cesarean section at 117-121 d estimated gestational age (EGA) (term = 145d), weighing 2.5 ± 0.35 kg. Lambs were cannulated using 10-14Fr cannulae for drainage via the right jugular vein and reinfusion via the umbilical vein. Lambs were intubated and lungs were filled with perfluorodecalin to a meniscus with a pressure of 5-8 cm H2O. The first option for transfusion was fetal whole blood from twins followed by maternal red blood cells. Arterial blood gases were used to titrate AP support to maintain fetal blood gas values. RESULTS The mean survival time on circuit was 119.6 ± 39.5 h. Hemodynamic parameters and lactate were stable throughout. As more adult blood transfusions were given to maintain hemoglobin at 10 mg/dL, the HbF% declined, reaching 40% by post operative day 7. The HbF% was inversely proportional to flow rates as higher flows were required to maintain adequate oxygen saturation and perfusion. CONCLUSIONS Transfusion of adult blood led to decreased fetal hemoglobin concentration during AP support. The HbF% was inversely proportional to flow rates. Future directions include strategies to decrease the priming volume and establishing a fetal blood bank to have blood rich in HbF.
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Affiliation(s)
- Brianna L Spencer
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brian P Fallon
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer S McLeod
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Marie Cornell
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Erin E Perrone
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Michigan Medicine, Ann Arbor, MI, USA
| | - David M Manthei
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Alvaro Rojas-Peña
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Surgery, Section of Transplantation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ronald B Hirschl
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Michigan Medicine, Ann Arbor, MI, USA
| | - Robert H Bartlett
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
| | - George B Mychaliska
- Department of Surgery, ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Surgery, Section of Pediatric Surgery, University of Michigan Michigan Medicine, Ann Arbor, MI, USA
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Tomiyama M, Takayama S, Konno H, Murakoshi T, Koga M, Nakamura M, Yamashiro Y, Matsubayashi T. ( G γ A γ δ β ) 0 $({}^{\rm G}{\gamma}{}^{\rm A}{\gamma}\delta\beta)^0$ -Thalassemia: Report of two cases in a family. Pediatr Blood Cancer 2023; 70:e30666. [PMID: 37712671 DOI: 10.1002/pbc.30666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Case 1 presented with severe anemia and received an intrauterine blood cell transfusion at 33 weeks of gestation. The anemia spontaneously improved in early infancy. Case 2, the father of Case 1, had an uneventful birth with no evidence of anemia, though microcytic anemia was observed during childhood. The genetic analysis of the β-globin gene cluster identified a novel heterozygous deletion of DNA extending from the Gγ-globin gene downstream to the β-globin gene, confirming a diagnosis of (G γA γδβ)0 -thalassemia. In cases where thalassemia is suspected based on blood tests, a genetic diagnosis should be performed for the sake of the offspring.
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Affiliation(s)
- Mana Tomiyama
- Department of Pediatrics, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Saki Takayama
- Department of Pediatrics, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Hiroko Konno
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Masafumi Koga
- Department of Internal Medicine, Hakuhokai Central Hospital, Hyogo, Japan
| | - Momoko Nakamura
- Division of Clinical Laboratory Science, Faculty of Health Sciences, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Yasuhiro Yamashiro
- Division of Clinical Laboratory Science, Faculty of Health Sciences, Yamaguchi University School of Medicine, Yamaguchi, Japan
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5
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Teofili L, Papacci P, Giannantonio C, Bianchi M, Giovanna Valentini C, Vento G. Allogenic Cord Blood Transfusion in Preterm Infants. Clin Perinatol 2023; 50:881-893. [PMID: 37866854 DOI: 10.1016/j.clp.2023.07.005] [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] [Indexed: 10/24/2023]
Abstract
Repeated red blood cell (RBC) transfusions in preterm neonates cause the progressive displacement of fetal hemoglobin (HbF) by adult hemoglobin. The ensuing increase of oxygen delivery may result at the cellular level in a dangerous condition of hyperoxia, explaining the association between low-HbF levels and retinopathy of prematurity or bronchopulmonary dysplasia. Transfusing preterm neonates with RBC concentrates obtained from allogeneic umbilical blood is a strategy to increase hemoglobin concentration without depleting the physiologic HbF reservoir. This review summarizes the mechanisms underlying a plausible beneficial impact of this strategy and reports clinical experience gathered so far in this field.
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Affiliation(s)
- Luciana Teofili
- Transfusion Medicine Department, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli 8, Rome, Italy.
| | - Patrizia Papacci
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli 8, Rome, Italy
| | - Carmen Giannantonio
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, Rome, Italy
| | - Maria Bianchi
- Transfusion Medicine Department, Fondazione Policlinico A. Gemelli IRCCS, Largo Gemelli 8, Rome, Italy
| | | | - Giovanni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli 8, Rome, Italy
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Stark CM, Juul SE. New frontiers in neonatal red blood cell transfusion research. J Perinatol 2023; 43:1349-1356. [PMID: 37667005 DOI: 10.1038/s41372-023-01757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023]
Abstract
Red blood cell (RBC) transfusions are common in neonates requiring intensive care. Recent studies have compared restricted versus liberal transfusion guidelines, but limitations exist on evaluations of outcomes in populations that never required a transfusion compared to those receiving any transfusion. Although there are well-established risks associated with RBC transfusions, new data has emerged that suggests additional clinically relevant associations, including adverse neurodevelopmental outcomes, donor sex differences, and inflammation or immunosuppression. Further research is needed to delineate the magnitude of these risks and to further improve the safety of transfusions. The goal of this review is to highlight underappreciated, yet clinically important risks associated with neonatal RBC transfusions and to introduce several areas in which neonates may uniquely benefit from alterations in practice.
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Affiliation(s)
- Christopher M Stark
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Sandra E Juul
- Institute on Human Development and Disability (IHDD) and the Intellectual and Developmental Disabilities Research Center (IDDRC), Department of Pediatrics, University of Washington, Seattle, WA, USA
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7
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Torrejon-Rodriguez L, Pinilla-Gonzalez A, Lara Cantón I, Albiach-Delgado A, Cascant-Vilaplana MM, Cernada M, Kuligowski J, Solves Alcaina MP, Gómez I, Vento M, Aguar Carrascosa M. Effect of autologous umbilical cord blood transfusion in the development of retinopathy of prematurity: randomized clinical trial - study protocol. Front Pediatr 2023; 11:1269797. [PMID: 37900679 PMCID: PMC10602804 DOI: 10.3389/fped.2023.1269797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
Background Currently, the treatment of anemia in preterm infants is based on packed red blood cell (RBC) transfusions from adult donors. Oxygen (O2) is mainly transported to the tissues bound to hemoglobin (Hb). In extremely low gestational age neonates (ELGANs), fetal hemoglobin (HbF), which has a higher affinity for O2, represents up to 95% of circulating hemoglobin. During the first month of life, the majority of ELGANs will require an adult-donor RBC transfusion causing HbF levels to rapidly drop. HbA releases 50% more oxygen in peripheral tissues than HbF. Increased release of O2 in the retina is one of the main factors related to the development of retinopathy of prematurity (ROP). Collecting umbilical cord blood and using autologous umbilical cord whole blood (UCB) transfusions would contribute to maintaining physiological HbF concentrations in newborns and avoid oxygen-in-excess derived damage. Methods This is a randomized, double-blinded, multicenter clinical trial. ELGANs ≤28 weeks of gestational age will be randomized 1:1 to receive an autologous umbilical cord blood transfusion (intervention arm) or standard transfusion of packed RBC from an adult donor (control arm) to assess ROP development. Assuming a 50% reduction in ROP incidence, 134 patients (67 per group) will be recruited. When blood transfusion is indicated, the Blook Bank will supply UCB or RCB according to the patient's group. The primary endpoint is the incidence of any ROP. Secondary endpoints are assessessment of treatment safety, results of biomarkers related to ROP and its chronology, and urine oxidative stress markers. In addition, the cellular composition of umbilical cord blood and its relationship with prematurity-related pathologies will be analyzed. All patients will be followed-up to 24 months of corrected age to evaluate their neurodevelopment. Discussion ROP is a major cause of irreversible blindness in preterm newborns. Transfusions with adult donor blood can lead to complications, including ROP. UCB transfusions offer advantages by maintaining physiological HbF levels and potentially optimizing postnatal development. Moreover, autologous UCB transfusion could reduce risks associated with heterologous blood products, although volume collection remains challenging. UCB contains growth factors and progenitor cells that may impact ROP.
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Affiliation(s)
- Laura Torrejon-Rodriguez
- Department of Neonatology, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | | | - Inmaculada Lara Cantón
- Department of Neonatology, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Abel Albiach-Delgado
- Neonatal Research Group, Hospital Universitario y Politécnico La Fe (HULAFE), Valencia, Spain
| | | | - María Cernada
- Department of Neonatology, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Julia Kuligowski
- Neonatal Research Group, Hospital Universitario y Politécnico La Fe (HULAFE), Valencia, Spain
| | | | - Inés Gómez
- Department of Hematology, Hospital Universitario y Politécnico La Fe (HULAFE), Valencia, Spain
| | - Maximo Vento
- Neonatal Research Group, Hospital Universitario y Politécnico La Fe (HULAFE), Valencia, Spain
| | - Marta Aguar Carrascosa
- Department of Neonatology, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
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Bellach L, Eigenschink M, Hassanein A, Savran D, Salzer U, Müllner EW, Repa A, Klebermass-Schrehof K, Wisgrill L, Giordano V, Berger A. Packed red blood cell transfusion in preterm infants. Lancet Haematol 2022; 9:e615-e626. [PMID: 35901846 DOI: 10.1016/s2352-3026(22)00207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Premature infants commonly receive adult packed red blood cells (pRBCs) during their hospital stay. As adult erythrocytes differ substantially from those of preterm infants, transfusion of adult pRBCs into preterm infants can be considered inappropriate for the physiology of a preterm infant. An absence of standardisation of transfusion protocols makes it difficult to compare and interpret pertinent clinical data, as reflected by unclear associations between pRBC transfusion and complications related to prematurity, such as bronchopulmonary dysplasia, neurodevelopmental impairment, retinopathy of prematurity, or necrotising enterocolitis. The difficulty in interpreting clinical data is further increased by differences in study designs that either overestimate pRBC-associated complications of prematurity or have not yet been designed to directly link pRBC transfusions to their respective complications. Thus, neonatal transfusion practice has become an ongoing difficulty, in which differences in transfusion guidelines hinder the ability to generate comparable clinical data, and heterogeneity in clinical data prevents the implementation of standardised transfusion protocols. To overcome these issues, novel approaches with biochemical-clinical translational designs could enable clinicians to gather causal evidence instead of circumstantial correlation.
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Affiliation(s)
- Luise Bellach
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Eigenschink
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Abtin Hassanein
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Danylo Savran
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Ulrich Salzer
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Ernst W Müllner
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Wisgrill
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
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9
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Morphology and biological data in cord blood eryhtrocyte units resembles adult units after processing and storage – Meets current quality recommendations. Transfus Apher Sci 2022; 61:103356. [DOI: 10.1016/j.transci.2022.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 11/18/2022]
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10
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Letter to the Editor in response to: Fetal hemoglobin levels in premature newborns. J Pediatr Surg 2021; 56:2407-2408. [PMID: 34325880 DOI: 10.1016/j.jpedsurg.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
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11
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Dougherty D, Perrone EE. Author response to fetal hemoglobin levels in premature newborns. J Pediatr Surg 2021; 56:2409. [PMID: 34454719 DOI: 10.1016/j.jpedsurg.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Danielle Dougherty
- Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA; Fetal Diagnosis and Treatment Center, C.S. Mott Children's Hospital, Pediatric Surgery, University of Michigan, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA
| | - Erin E Perrone
- Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA; Fetal Diagnosis and Treatment Center, C.S. Mott Children's Hospital, Pediatric Surgery, University of Michigan, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA.
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