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Ma T, Yang J, Sun Y, Song A, Zhang J, Shen Y, Hua K, Wu W, Chen W. Evaluation of the impact of diagnostic blood loss and red blood cell transfusion in very-low-birth-weight anaemic neonates during hospitalization: A multi-centre retrospective clinical study. Vox Sang 2024; 119:467-475. [PMID: 38419273 DOI: 10.1111/vox.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Diagnostic blood loss is a significant factor in the development of anaemia in neonates with very low birth weight. This study aimed to assess the clinical efficacy of intervention approaches involving varying diagnostic blood loss and red blood cell transfusion volumes in neonates with very low birth weights experiencing anaemia during hospitalization. MATERIALS AND METHODS A total of 785 newborns with anaemia weighing less than 1500 g were enrolled from 32 hospitals in China. The study involved monitoring diagnostic blood loss and red blood cell transfusion and evaluating relevant interventions such as red blood cell transfusion and clinical outcomes. Three intervention approaches were established based on the difference between blood loss and transfusion (Intervention Approaches 0, 1 and 2). The primary outcomes measured were unsatisfactory weight gain during hospitalization and neonatal mortality. The secondary outcomes included related complications. RESULTS In the non-hospital-acquired anaemia group, Intervention Approach 2 had the highest incidence of below-normal weight gain (odds ratio [OR]: 3.019, 95% confidence interval [CI]: 1.081-8.431, p = 0.035). Multivariate analysis revealed that Intervention Approach 1 had a protective effect on weight gain. In the hospital-acquired anaemia group, Intervention Approach 2 had the highest incidence of below-normal weight gain (OR: 3.335, 95% CI: 1.785-6.234, p = 0.000) and mortality (OR: 5.341, 95% CI: 2.449-11.645, p = 0.000), while Intervention Approach 1 had the lowest incidence of intraventricular haemorrhage. Intervention Approach 1 demonstrated favourable outcomes in both anaemia groups. CONCLUSION Intervention Approach 1 improved weight gain and reduced mortality and complications in both the non-hospital-acquired and hospital-acquired anaemia groups.
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Affiliation(s)
- Ting Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jiangcun Yang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yang Sun
- Department of Data Center, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Aowei Song
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jin Zhang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yuan Shen
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Kai Hua
- College of Life Sciences, Northwest University, Xi'an, Shaanxi, China
| | - Wenjing Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wei Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Lopriore E. The total volume of blood in an extremely preterm neonate is about the size of a double espresso. Acta Paediatr 2023; 112:2458-2459. [PMID: 37789693 DOI: 10.1111/apa.16994] [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: 09/13/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Enrico Lopriore
- Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
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3
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Moore CM, O'Sullivan S, Curley AE. Parents' understanding and experiences of blood component transfusion in the neonatal intensive care unit: A qualitative study. Acta Paediatr 2023; 112:2493-2502. [PMID: 37615240 DOI: 10.1111/apa.16952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
AIM Blood component transfusion is a common intervention in the neonatal intensive care unit (NICU). Parents consent on their babies' behalf. This study aimed to explore parents' understandings and experiences of consenting and the subsequent blood transfusion. METHODS A "low inference" qualitative descriptive semi-structured interview approach was utilised. Grounded theory was employed. Parents described their memories of babies' transfusions, their responses to the consent process and assessed the written information they were given. RESULTS A purposive sample of 17 parents whose babies required blood transfusion in the NICU participated. Parents talked about their initial fears of transfusion, later replaced by confidence in the process and results of transfusion and trust in the healthcare professional team. The main themes elicited by the interviews were parents' expectations and outcomes of transfusion, parents' prior and current opinions of transfusion, parents trust in healthcare professionals and how parents would like to receive information about transfusions in the NICU. CONCLUSION Parents in our study trust information from the healthcare professionals caring for their baby and would like more specific information about how blood transfusion will impact their baby, in a variety of means. Parents felt that blood transfusions were beneficial for their babies.
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Affiliation(s)
- Carmel Maria Moore
- School of Medicine, University College Dublin, Dublin 4, Ireland
- Neonatology, National Maternity Hospital, Dublin 2, Ireland
| | - Sara O'Sullivan
- School of Sociology, University College Dublin, Dublin 4, Ireland
| | - Anna E Curley
- School of Medicine, University College Dublin, Dublin 4, Ireland
- Neonatology, National Maternity Hospital, Dublin 2, Ireland
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Impact of Early Hemoglobin Levels on Neurodevelopment Outcomes of Two-Year-Olds in Very Preterm Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020209. [PMID: 36832338 PMCID: PMC9955539 DOI: 10.3390/children10020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate, in very preterm infants, the hemoglobin (Hb) levels during the first 24 h and the neurodevelopment outcomes at 24 months of corrected age. DESIGN, SETTING, AND PATIENTS We conducted a secondary analysis of the French national prospective and population-based cohort EPIPAGE-2. The eligible study participants were live-born singletons who were born before 32 weeks of gestational age, with early Hb levels who were admitted to the neonatal intensive care unit. MAIN OUTCOME MEASURES The early Hb levels for an outcome survival at 24 months of corrected age without neurodevelopmental impairment were measured. The secondary outcomes were survival at discharge and without severe neonatal morbidity. RESULTS Of the 2158 singletons of <32 weeks with mean early Hb levels of 15.4 (±2.4) g/dL, 1490 of the infants (69%) had a follow-up at two years of age. An early Hb of 15.2 g/dL is the minimum receiving operating characteristic curve at the 24 months risk-free level, but the area under the curve at 0.54 (close to 50%) indicates that this rate was not informative. In logistic regression, no association was found between early Hb levels and outcomes at two years of age (aOR 0.966; 95% CI [0.775-1.204]; p = 0.758) but rather there was a correlation found with severe morbidity (aOR 1.322; 95% CI [1.003-1.743]; p = 0.048). A risk stratification tree showed that male newborns of >26 weeks with Hb of <15.5 g/dL (n = 703) were associated with a poor outcome at 24 months (OR 1.9; CI: [1.5-2.4] p < 0.01). CONCLUSIONS Early low Hb levels are associated with major neonatal morbidities in VP singletons, but not with neurodevelopment outcomes at two years of age, except in male infants of >26 Weeks GA.
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Boix H, Sánchez-Redondo MD, Cernada M, Espinosa Fernández MG, González-Pacheco N, Martín A, Pérez-Muñuzuri A, Couce ML. Recomendaciones para la transfusión de hemoderivados en neonatología. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Recommendations for transfusion of blood products in neonatology. An Pediatr (Barc) 2022; 97:60.e1-60.e8. [PMID: 35725819 DOI: 10.1016/j.anpede.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
The scant evidence on the use of transfusions in neonatal care explains the limitations of current clinical guidelines. Despite this, in this document we explore the most recent evidence to make recommendations for the clinical practice. The prevention of anaemia of prematurity, the use of protocols and restrictive transfusion strategies constitute the best approach for clinicians in this field. In the case of platelet transfusions, the risk of bleeding must be assessed, combining clinical and laboratory features. Lastly, fresh frozen plasma is recommended in neonates with coagulopathy and active bleeding, with congenital factor deficiencies for which there is no specific treatment or with disseminated intravascular coagulation. All blood products have adverse effects that warrant a personalised and thorough assessment of the need for transfusion.
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Maheshwari A. Role of platelets in neonatal necrotizing enterocolitis. Pediatr Res 2021; 89:1087-1093. [PMID: 32601461 PMCID: PMC7770063 DOI: 10.1038/s41390-020-1038-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/23/2022]
Abstract
Necrotizing enterocolitis (NEC) is an inflammatory bowel necrosis of premature infants and is a leading cause of morbidity and mortality in infants born between 23 and 28 weeks of gestation. Fifty to 95% of all infants with NEC develop thrombocytopenia (platelet counts <150 × 109/L) within 24-72 h of receiving this diagnosis. In many patients, thrombocytopenia is severe and is treated with one or more platelet transfusions. However, the underlying mechanism(s) and biological implications of NEC-related thrombocytopenia remain unclear. This review presents current evidence from human and animal studies on the clinical features and mechanisms of platelet depletion in NEC. Anecdotal clinical experience is combined with evidence from laboratory studies and from an extensive literature search in databases PubMed, EMBASE, and Scopus and the electronic archives of abstracts presented at the annual meetings of the Pediatric Academic Societies. To avoid bias in identification of existing studies, key words were short-listed prior to the actual search both from anecdotal experience and from PubMed's Medical Subject Heading (MeSH) thesaurus. IMPACT: Fifty to 95% of infants with necrotizing enterocolitis (NEC) develop idiopathic thrombocytopenia (platelet counts <150 × 109/L) within 24-72 h of disease onset. Early clinical trials suggest that moderate thrombocytopenia may be protective in human NEC, although further work is needed to fully understand this relationship. We have developed a neonatal murine model of NEC-related thrombocytopenia, where enteral administration of an immunological stimulant, trinitrobenzene sulfonate, on postnatal day 10 induces an acute necrotizing ileocolitis resembling human NEC. In this murine model, thrombocytopenia is seen at 15-18 h due to platelet consumption and mild-moderate thrombocytopenia is protective.
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Affiliation(s)
- Akhil Maheshwari
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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8
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Barboza JJ, Albitres-Flores L, Rivera-Meza M, Rodriguez-Huapaya J, Caballero-Alvarado J, Pasupuleti V, Hernandez AV. Short-term efficacy of umbilical cord milking in preterm infants: systematic review and meta-analysis. Pediatr Res 2021; 89:22-30. [PMID: 32316030 DOI: 10.1038/s41390-020-0902-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND To systematically evaluate short-term efficacy of UCM versus other interventions in preterm infants. METHODS Six engines were searched until February 2020 for randomized controlled trials (RCTs) assessing UCM versus immediate cord clamping (ICC), delayed cord clamping (DCC), or no intervention. Primary outcomes were overall mortality, intraventricular hemorrhage (IVH), and patent ductus arteriosus (PDA); secondary outcomes were need for blood transfusion, mean blood pressure (MBP), serum hemoglobin (Hb), and ferritin levels. Random-effects meta-analyses were used. RESULTS Fourteen RCTs (n = 1708) were included. In comparison to ICC, UCM did not decrease mortality (RR 0.5, 95% CI 0.2-1.1), IVH (RR 0.7, 95% CI 0.5-1.0), or PDA (RR 1.0, 95% CI 0.7-1.5). However, UCM reduced need of blood transfusion (RR 0.5, 95% CI 0.3-0.9) and increased MBP (MD 2.5 mm Hg, 95% CI 0.5-4.5), Hb (MD 1.2 g/dL, 95% CI 0.8-1.6), and ferritin (MD 151.4 ng/dL, 95% CI 59.5-243.3). In comparison to DCC, UCM did not reduce mortality, IVH, PDA, or need of blood transfusion but increased MBP (MD 3.7, 95% CI 0.6-6.9) and Hb (MD 0.3, 95% CI -0.2-0.8). Only two RCTs had high risk of bias. CONCLUSIONS UCM did not decrease short-term clinical outcomes in comparison to ICC or DCC in preterm infants. Intermediate outcomes improved significantly with UCM. IMPACT In 14 randomized controlled trials (RCTs), umbilical cord milking (UCM) did not reduce mortality, intraventricular hemorrhage, or patent ductus arteriosus compared to immediate (ICC) or delayed cord clamping (DCC). UCM improved mean blood pressure and hemoglobin levels compared to ICC or DCC. In comparison to ICC, UCM reduced the need for blood transfusion. We updated searches until February 2020, stratified by type of control, and performed subgroup analyses. There was low quality of evidence about clinical efficacy of UCM. Most of RCTs had low risk of bias. UCM cannot be recommended as standard of care for preterm infants.
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Affiliation(s)
- Joshuan J Barboza
- Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola (USIL), Lima, Peru. .,TAU-RELAPED Group, Trujillo, Peru.
| | - Leonardo Albitres-Flores
- TAU-RELAPED Group, Trujillo, Peru.,Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Peru
| | | | | | - José Caballero-Alvarado
- TAU-RELAPED Group, Trujillo, Peru.,Escuela de Postgrado, Universidad Privada Antenor Orrego, Trujillo, Peru
| | | | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
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9
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Zerra PE, Josephson CD. Transfusion in Neonatal Patients: Review of Evidence-Based Guidelines. Clin Lab Med 2020; 41:15-34. [PMID: 33494882 DOI: 10.1016/j.cll.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transfusion of red blood cells, platelets, and fresh frozen plasma in neonatal patients has not been well characterized in the literature, with guidelines varying greatly between institutions. However, anemia and thrombocytopenia are highly prevalent, especially in preterm neonates. When transfusing a neonatal patient, clinicians must take into consideration physiologic differences, gestational and postnatal age, congenital disorders, and maternal factors while weighing the risks and benefits of transfusion. This review of existing literature summarizes current evidence-based neonatal transfusion guidelines and highlights areas of current ongoing research and those in need of future studies.
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Affiliation(s)
- Patricia E Zerra
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA
| | - Cassandra D Josephson
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA.
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10
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Tao E, Ye D, Long G, Hu Y, Fu Q, Yuan T, Jiang M. Severe neonatal anemia affected by massive fetomaternal hemorrhage: a single-center retrospective observational study. J Matern Fetal Neonatal Med 2020; 35:3972-3978. [PMID: 33183095 DOI: 10.1080/14767058.2020.1845313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Massive fetomaternal hemorrhage (FMH) is a rare but sometimes life-threatening event, and surviving neonates may suffer major neurological complications. Severe neonatal anemia (SNA) affected by massive FMH is less reported in the literature. This study aims to explore the clinical characteristics, laboratory diagnoses, treatments and outcomes of SNA affected by massive FMH. METHODS Data were collected retrospectively from the hospital's electronic medical record system. All neonates born in the hospital and admitted to the neonatal unit diagnosed as SNA affected by massive FMH from 1 January 2013 to 31 June 2017 were included. RESULTS A total of 8 cases of SNA affected by FMH were identified among 6825 neonates admitted to the neonatal unit. They all presented with pallor but without hydrops at birth. Median gestational age and birthweight were 375/7 (360/7‒401/7) weeks and 2,625 (2300‒3050) g, respectively. Median hemoglobin level was 39.5 (25‒53) g/L at birth and 109.5 (94-127) g/L at discharge. Median maternal serum alpha-fetoprotein (AFP) was 3958.5 (1606‒14,330) ng/mL, which was significantly increased. Three out of eight cases manifested as antenatal decreased fetal movement. Only 1 with the lowest initial hemoglobin 25 g/L manifested as characteristic sinusoidal fetal heart rate tracing and suffered severe neonatal asphyxia and hypovolemic shock. Having experienced resuscitation, he was admitted to the neonatal unit and received twice transfusion of cross-matched red blood cells there. Another case with the initial hemoglobin 45 g/L received positive pressure ventilation and once transfusion. All cases were successfully discharged with a median hospital stay of 8 (5-12) days. Follow-up was available for 6 (75%) of 8 neonates (age range 13 months to 50 months), and all infants were observed to be in good condition with normal neurological status. In our series of eight cases, there were no neonatal deaths. CONCLUSION This study strengthens the idea that maternal AFP testing is valuable to confirm massive fetomaternal hemorrhage. Surviving neonates of massive FMH might have a good outcome despite severe anemia at birth.
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Affiliation(s)
- Enfu Tao
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, China
| | - Diya Ye
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Gao Long
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuting Hu
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qibo Fu
- Office of National Clinical Research Center for Child Health, Childrens Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tianming Yuan
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Mizu Jiang
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Gastroenterology, Children's Hospital, Zhejiang Universiy School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
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Abstract
INTRODUCTION Thrombocytopaenia is one of the most common haemostatic abnormalities among neonates. It affects approximately one-quarter of neonates admitted into neonatal intensive care units and may lead to a high risk of bleeding and mortality, which are substantial causes for concern by neonatologists. Platelet transfusion (PT) is a specific treatment for thrombocytopaenia. To date, PT thresholds are diverse since the associations between low platelet count and negative outcomes are not clear. We propose this protocol for a systematic review to collect and assess evidence concerning the best PT threshold to reduce mortality, bleeding and major morbidity among neonates with thrombocytopaenia. METHODS AND ANALYSIS The systematic review will be performed according to the Cochrane Handbook for Systematic Review of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the Grading of Recommendations Assessment, Development and Evaluation system. Two independent researchers will perform the study selection, data extraction/coding, quality assessment and further analyses of the included studies, with disagreements being resolved by a third researcher. A systematic search of the literature will be conducted in the PubMed, Cochrane Library and Embase databases from database inception through 13 October 2020. All randomised controlled trials, cohort studies and case-control studies will be included without any restrictions regarding publication date or language. The primary outcomes will comprise in-hospital mortality and bleeding episodes. Endnote X9 and Review Manager V.5.3 software will be used to manage the selection process and statistical analysis, respectively. If the included studies are sufficient and homogeneous for any of the outcomes, a quantitative synthesis (meta-analysis) may be performed. Otherwise, we will conduct a narrative systematic review of the results. ETHICS AND DISSEMINATION Ethical approval is not required for this study because the data will be obtained from published studies and will not include individual patient data. The results of this study are anticipated to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020169262.
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Affiliation(s)
- Dengjun Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Jinlin Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Yan Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Sichuan University, Chengdu, China
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12
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Juul SE, Vu PT, Comstock BA, Wadhawan R, Mayock DE, Courtney SE, Robinson T, Ahmad KA, Bendel-Stenzel E, Baserga M, LaGamma EF, Downey LC, O’Shea M, Rao R, Fahim N, Lampland A, Frantz ID, Khan J, Weiss M, Gilmore MM, Ohls R, Srinivasan N, Perez JE, McKay V, Heagerty PJ. Effect of High-Dose Erythropoietin on Blood Transfusions in Extremely Low Gestational Age Neonates: Post Hoc Analysis of a Randomized Clinical Trial. JAMA Pediatr 2020; 174:933-943. [PMID: 32804205 PMCID: PMC7432302 DOI: 10.1001/jamapediatrics.2020.2271] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Extremely preterm infants are among the populations receiving the highest levels of transfusions. Erythropoietin has not been recommended for premature infants because most studies have not demonstrated a decrease in donor exposure. OBJECTIVES To determine whether high-dose erythropoietin given within 24 hours of birth through postmenstrual age of 32 completed weeks will decrease the need for blood transfusions. DESIGN, SETTING, AND PARTICIPANTS The Preterm Erythropoietin Neuroprotection Trial (PENUT) is a randomized, double-masked clinical trial with participants enrolled at 19 sites consisting of 30 neonatal intensive care units across the United States. Participants were born at a gestational age of 24 weeks (0-6 days) to 27 weeks (6-7 days). Exclusion criteria included conditions known to affect neurodevelopmental outcomes. Of 3266 patients screened, 2325 were excluded, and 941 were enrolled and randomized to erythropoietin (n = 477) or placebo (n = 464). Data were collected from December 12, 2013, to February 25, 2019, and analyzed from March 1 to June 15, 2019. INTERVENTIONS In this post hoc analysis, erythropoietin, 1000 U/kg, or placebo was given every 48 hours for 6 doses, followed by 400 U/kg or sham injections 3 times a week through postmenstrual age of 32 weeks. MAIN OUTCOMES AND MEASURES Need for transfusion, transfusion numbers and volume, number of donor exposures, and lowest daily hematocrit level are presented herein. RESULTS A total of 936 patients (488 male [52.1%]) were included in the analysis, with a mean (SD) gestational age of 25.6 (1.2) weeks and mean (SD) birth weight of 799 (189) g. Erythropoietin treatment (vs placebo) decreased the number of transfusions (unadjusted mean [SD], 3.5 [4.0] vs 5.2 [4.4]), with a relative rate (RR) of 0.66 (95% CI, 0.59-0.75); the cumulative transfused volume (mean [SD], 47.6 [60.4] vs 76.3 [68.2] mL), with a mean difference of -25.7 (95% CI, 18.1-33.3) mL; and donor exposure (mean [SD], 1.6 [1.7] vs 2.4 [2.0]), with an RR of 0.67 (95% CI, 0.58-0.77). Despite fewer transfusions, erythropoietin-treated infants tended to have higher hematocrit levels than placebo-treated infants, most noticeable at gestational week 33 in infants with a gestational age of 27 weeks (mean [SD] hematocrit level in erythropoietin-treated vs placebo-treated cohorts, 36.9% [5.5%] vs 30.4% [4.6%] (P < .001). Of 936 infants, 160 (17.1%) remained transfusion free at the end of 12 postnatal weeks, including 43 in the placebo group and 117 in the erythropoietin group (P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that high-dose erythropoietin as used in the PENUT protocol was effective in reducing transfusion needs in this population of extremely preterm infants. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01378273.
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Affiliation(s)
- Sandra E. Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Phuong T. Vu
- Department of Biostatistics, University of Washington, Seattle,now with Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | | | - Rajan Wadhawan
- Department of Neonatal-Perinatal Medicine, AdventHealth, Orlando, Florida
| | - Dennis E. Mayock
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle
| | - Sherry E. Courtney
- Division of Neonatology, Department of Pediatrics, University of Arkansas, Little Rock
| | - Tonya Robinson
- Division of Neonatology, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Kaashif A. Ahmad
- Department of Neonatal Medicine, Methodist Children’s Hospital, San Antonio, Texas
| | | | - Mariana Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City
| | - Edmund F. LaGamma
- Department of Neonatal Medicine, Maria Fareri Children’s Hospital at Westchester, Valhalla, New York
| | - L. Corbin Downey
- Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael O’Shea
- Division of Neonatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis
| | - Raghavendra Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis
| | - Nancy Fahim
- Division of Neonatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis
| | | | - Ivan D. Frantz
- Division of Neonatology, Department of Pediatrics, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Janine Khan
- Division of Neonatology, Department of Pediatrics, Prentice Women’s Hospital, Chicago, Illinois
| | - Michael Weiss
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville
| | - Maureen M. Gilmore
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Robin Ohls
- Division of Neonatology, Department of Pediatrics, University of New Mexico, Albuquerque
| | - Nishant Srinivasan
- Department of Pediatrics, Children’s Hospital of the University of Illinois, Chicago
| | - Jorge E. Perez
- Department of Neonatology, South Miami Hospital, South Miami, Florida
| | - Victor McKay
- Department of Neonatology, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
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13
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Balasubramanian H, Srinivasan L, Kabra N. Reply. J Pediatr 2019; 215:284. [PMID: 31542157 DOI: 10.1016/j.jpeds.2019.08.013] [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: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Affiliation(s)
| | - Lakshmi Srinivasan
- The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Human Umbilical Cord Blood Serum/Plasma: Cytokine Profile and Prospective Application in Regenerative Medicine. Bull Exp Biol Med 2019; 168:173-177. [PMID: 31761983 DOI: 10.1007/s10517-019-04670-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Indexed: 01/03/2023]
Abstract
The concentrations of cytokines and growth factors in human umbilical cord blood serum and plasma samples were measured by multiplex analysis. It was found that in comparison with peripheral blood serum of adult donors, umbilical cord blood serum and plasma contain significantly higher concentrations of the most studied molecules including IL-4, 5, 6, 7, 10 and 15, MCP-1, SCF, and SDF, as well as growth factors directly involved in the processes of regeneration (G-CSF, HGF, PDGF-BB, and VEGF). Thus, umbilical cord blood plasma and especially serum are a rich source of cytokines and growth factors with anti-inflammatory, anti-apoptotic, and angiogenic effects and can be used in various fields of regenerative medicine.
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15
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Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction. Early Hum Dev 2019; 140:104891. [PMID: 31669878 PMCID: PMC7180102 DOI: 10.1016/j.earlhumdev.2019.104891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Elevated cerebral fractional tissue oxygen extraction (cFTOE) is an adaptation to anemia of prematurity (AOP). cFTOE ≥0.4 is associated with brain injury in infants ≤30 weeks. This longitudinal study sought to investigate the utility of cFTOE in the evaluation of AOP. METHODS Infants ≤30 weeks estimated gestational age (EGA) underwent weekly hemoglobin, cerebral saturation, and pulse oximetry recordings from the second through 36 weeks post-menstrual age (PMA). Recordings were excluded if they were under 1 h or if hemoglobin was not measured within 7 days of recording. Mean cFTOE was calculated for each recording. Statistical analysis used linear mixed-effects modeling and receiver operating characteristic analysis. RESULTS 144 recordings from 39 infants (mean EGA 27.6 ± 2.2 weeks, BW 1139 ± 286 g) were included of whom 39% (15/39) were transfused. The mean recording length was 2.8 ± 1.3 h. There was a significant negative correlation between hemoglobin and cFTOE (R = -0.423, p ≤.001). In a multivariate model, adjusting for EGA, PMA, and patent ductus arteriosus treatment the AUC was 0.821. A critical increase in cFTOE occurred at a hemoglobin level of 9.6 g/dL. CONCLUSIONS AOP is associated with a critical increase in cFTOE that occurs at a significantly higher hemoglobin level than standard clinical thresholds for transfusion.
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16
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Counsilman CE, Heeger LE, Tan R, Bekker V, Zwaginga JJ, Te Pas AB, Lopriore E. Iatrogenic blood loss in extreme preterm infants due to frequent laboratory tests and procedures. J Matern Fetal Neonatal Med 2019; 34:2660-2665. [PMID: 31588840 DOI: 10.1080/14767058.2019.1670800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the cumulative amount of iatrogenic blood loss in extreme preterm infants during the first month of life. STUDY DESIGN We performed an observational cohort study in 20 extreme preterm infants (gestational age <28 weeks). We recorded the amount of blood drawn for laboratory testing during the first 4 weeks of life, the number of punctures for phlebotomy and intravenous access and the amount of blood loss associated with these procedures. We compared the cumulative blood loss to the estimated total blood volume (85 ml/kg body weight) and to the total volume of red blood cell (RBC) transfusions administered during the same study period. RESULTS The median cumulative iatrogenic blood loss was 24.2 ml/kg (interquartile range (IQR) 15.8-30.3 ml/kg) per patient, which equals a median of 28.5% (IQR 18.6-35.6%) of the total blood volume. Blood loss was higher in the most extreme preterm infants (30.2 ml/kg at 24 weeks versus 15.9 ml/kg at 27 weeks). The median number of punctures per infant was 47 (IQR 26-56) during the first 4 weeks of life. The median volume of RBC transfusions administered during the study period was 30 ml/kg, slightly more than the cumulative blood loss (24.2 ml/kg). CONCLUSIONS Extreme preterm infants lose almost one-third of their total blood volume in the first month of life as a result of blood loss due to multiple blood draws for laboratory investigations, and procedures.
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Affiliation(s)
- Clare E Counsilman
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisanne E Heeger
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ratna Tan
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent Bekker
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Immuno-Hematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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17
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Fustolo-Gunnink SF, Roehr CC, Lieberman L, Christensen RD, Van Der Bom JG, Dame C, Del Vecchio A, Keir AK, Curley A, Stanworth SJ, Lopriore E. Platelet and red cell transfusions for neonates: lifesavers or Trojan horses? Expert Rev Hematol 2019; 12:797-800. [PMID: 31423859 DOI: 10.1080/17474086.2019.1657824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Suzanne F Fustolo-Gunnink
- Sanquin Research, Center for Clinical Transfusion Research, Plesmanlaan 1A , Leiden , the Netherlands.,Department of Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology , Amsterdam , Netherlands
| | - Charles C Roehr
- Medical Sciences Division, Dept. Paediatrics, University of Oxford , Oxford , UK.,Newborn Services, John Radcliffe Hospital , Oxford , UK
| | - Lani Lieberman
- Department of Clinical Pathology, University Health Network, University of Toronto , Toronto , Canada
| | - Robert D Christensen
- Women and Newborn's Clinical Program, Intermountain Healthcare , Salt Lake City , UT , USA
| | - Johanna G Van Der Bom
- Sanquin Research, Center for Clinical Transfusion Research, Plesmanlaan 1A , Leiden , the Netherlands.,Department of Epidemiology, Leiden University Medical Center , Leiden , the Netherlands
| | - Christof Dame
- Department of Neonatology, Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Antonio Del Vecchio
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, "Di Venere" Hospital of Bari , Bari , Italy
| | - Amy K Keir
- Robinson Research Institute, Adelaide Medical School, University of Adelaide , Adelaide , Australia.,Department of Neonatal Medicine, Women's and Children's Hospital , Adelaide , Australia.,Healthy Mothers, Babies and Children, South Australian Medical and Research Institute , Adelaide , Australia
| | - Anna Curley
- Department of Neonatology, National Maternity Hospital , Dublin , Ireland
| | - Simon J Stanworth
- Transfusion Medicine, National Health Service (NHS) Blood and Transplant , Oxford , UK.,Department of Haematology, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme , Oxford , UK
| | - Enrico Lopriore
- Department of Pediatrics, Division of neonatology, Leiden University Medical Center , Leiden , the Netherlands
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18
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Christensen RD. Medicinal Uses of Hematopoietic Growth Factors in Neonatal Medicine. Handb Exp Pharmacol 2019; 261:257-283. [PMID: 31451971 DOI: 10.1007/164_2019_261] [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: 03/17/2023]
Abstract
This review focuses on certain hematopoietic growth factors that are used as medications in clinical neonatology. It is important to note at the chapter onset that although all of the pharmacological agents mentioned in this review have been approved by the US Food and Drug administration for use in humans, none have been granted a specific FDA indication for neonates. Thus, in a sense, all of the agents mentioned in this chapter could be considered experimental, when used in neonates. However, a great many of the pharmacological agents utilized routinely in neonatology practice do not have a specific FDA indication for this population of patients. Consequently, many of the agents reviewed in this chapter are considered by some practitioners to be nonexperimental and are used when they judge such use to be "best practice" for the disorders under treatment.The medicinal uses of the agents in this chapter vary considerably, between geographic locations, and sometimes even within an institutions. "Consistent approaches" aimed at using these agents in uniform ways in the practice of neonatology are encouraged. Indeed some healthcare systems, and some individual NICUs, have developed written guidelines for using these agents within the practice group. Some such guidelines are provided in this review. It should be noted that these guidelines, or "consistent approaches," must be viewed as dynamic and changing, requiring adjustment and refinement as additional evidence accrues.
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Affiliation(s)
- Robert D Christensen
- Divisions of Neonatology and Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. .,Intermountain Healthcare, Salt Lake City, UT, USA.
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19
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Aucott SW, Maheshwari A. To transfuse or not transfuse a premature infant: the new complex question. J Perinatol 2019; 39:351-353. [PMID: 30651578 DOI: 10.1038/s41372-018-0306-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Susan W Aucott
- The Charlotte R. Bloomberg Children's Center/Room 8530, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Akhil Maheshwari
- The Charlotte R. Bloomberg Children's Center/Room 8530, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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20
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Heeger LE, Counsilman CE, Bekker V, Bergman KA, Zwaginga JJ, te Pas AB, Lopriore E. Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change. Vox Sang 2019; 114:57-62. [PMID: 30407636 PMCID: PMC7379542 DOI: 10.1111/vox.12724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 09/07/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate red blood cell (RBC) transfusion practices in preterm neonates before and after protocol change. METHODS All preterm neonates (<32 weeks of gestation) admitted between 2008 and 2017 at our neonatal intensive care unit were included in this retrospective study. Since 2014, a more restrictive transfusion guideline was implemented in our unit. We compared transfusion practices before and after this guideline change. Primary outcome was the number of transfusions per neonate and the percentage of neonates receiving a blood transfusion. Secondary outcomes were neonatal morbidities and mortality during admission. RESULTS The percentage of preterm neonates requiring a blood transfusion was 37·5% (405/1079) before and 32·7% (165/505) after the protocol change (P = 0·040). The mean number of transfusions given to each transfused neonate decreased from 2·93 (standard deviation (SD) ± 2·26) to 2·20 (SD ±1·29) (P = 0·007). We observed no association between changes in transfusion practices and neonatal outcome. CONCLUSION The use of a more restrictive transfusion guideline leads to a reduction in red blood cell transfusions in preterm neonates, without evidence of an increase in mortality or short-term morbidity.
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Affiliation(s)
- Lisanne E. Heeger
- Division of NeonatologyDepartment of PediatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Clare E. Counsilman
- Division of NeonatologyDepartment of PediatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Vincent Bekker
- Division of NeonatologyDepartment of PediatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Klasien A. Bergman
- Division of NeonatologyUniversity Medical Center GroningenBeatrix Children's HospitalUniversity GroningenGroningenThe Netherlands
| | - Jaap Jan Zwaginga
- Sanquin ResearchCenter for Clinical Transfusion ResearchLeidenThe Netherlands
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenThe Netherlands
| | - Arjan B. te Pas
- Division of NeonatologyDepartment of PediatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Enrico Lopriore
- Division of NeonatologyDepartment of PediatricsLeiden University Medical CenterLeidenThe Netherlands
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21
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Çetinkaya M, Atasay B, Perk Y. Turkish Neonatal Society guideline on the transfusion principles in newborns. Turk Arch Pediatr 2018; 53:S101-S108. [PMID: 31236023 PMCID: PMC6568302 DOI: 10.5152/turkpediatriars.2018.01810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blood transfusion can be defined as a life-saving procedure in neonates, especially in premature and surgical infants. The indications, threshold hemoglobin, and platelet levels for red cell, platelet, and plasma transfusions in neonates vary among centers and the evidence-based data for possible adverse effects, preterm morbidities, mortality, and neuro-developmental problems associated with transfusions are not clear yet. Herein, we aim to present the transfusion guideline designed to be used in neonatal intensive care units in our country, summarizing clinical findings and threshold levels for red cell, platelet, and plasma transfusions in addition to important practical points of transfusions according to a literature review.
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Affiliation(s)
- Merih Çetinkaya
- Department of Neonatology, Health Sciences University, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Begüm Atasay
- Division of Neonatology, Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Yıldız Perk
- Division of Neonatology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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22
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Neonatale Thrombozytopenie. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Levine E, Beroul N, Cortey A, Damais Cepitelli A, Gouezec H, Pujol S, Wibaut B, Marti B. [Blood transfusion in neonatology: Study of practical aspects in 2016 in France, excluding acute bleeding or surgical care]. Transfus Clin Biol 2018; 25:249-256. [PMID: 30193925 DOI: 10.1016/j.tracli.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Blood transfusion is common in neonatology, especially in preterm or low birth weight infants. Recommendations were proposed by the French National Authority of Health (HAS) in 2014 and 2015 for red blood cells and platelet transfusion respectively, but an heterogeneity of practical attitudes persist. The objective of this survey is to evaluate transfusion practices in neonatal intensive care units. METHODS Investigation of practice of neonatal transfusion was organized among 68 neonatal intensive care unit (level 3) between September 2016 and May 2017, by mailing survey focused on systematic training of nurses, patient identification, immunohematology, information and technical aspects of blood components administration. RESULTS Twenty-three neonatal intensive care units among the 68s answered the questionnaire. One thousand five hundred sixty seven neonates were transfused and 3382 blood products were administered. The results highlight a consensual attitude concerning the procedures of patient identification, immunohematology tests and blood products administration. However, heterogeneity remains concerning information of the parents or the person with parental authority, immediate and delayed follow-up and devices used for the transfusion. However HAS guidelines (2014 and 2015) appear to be well applied by clinicians for blood products, specifications and calcul of transfused volume based on gestational age and weight.
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Affiliation(s)
- E Levine
- Service de néonatologie, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | - N Beroul
- Centre national de référence en hémobiologie périnatale, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Cortey
- Centre national de référence en hémobiologie périnatale, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Damais Cepitelli
- Unité d'hémovigilance, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France
| | - H Gouezec
- Hôpital Pontchaillou, CHU de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - S Pujol
- CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - B Wibaut
- Pôle d'hémobiologie transfusion, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - B Marti
- Agence régionale de santé Nouvelle-Aquitaine, 103, bis rue Belleville, CS 91704, 33063 Bordeaux cedex, France
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Whitehead HV, Vesoulis ZA, Maheshwari A, Rao R, Mathur AM. Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised? J Perinatol 2018; 38:1022-1029. [PMID: 29740185 PMCID: PMC6136959 DOI: 10.1038/s41372-018-0120-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/03/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the impact of progressive anemia of prematurity on cerebral regional saturation (C-rSO2) in preterm infants and identify the hemoglobin threshold below which a critical decrease (>2SD below the mean) in C-rSO2 occurs. STUDY DESIGN In a cohort of infants born ≤30 weeks EGA, weekly C-rSO2 data were prospectively collected from the second week of life through 36 weeks post-menstrual age (PMA). Clinically obtained hemoglobin values were noted at the time of recording. Recordings were excluded if they were of insufficient duration (<1 h) or if the hemoglobin was not measured within 7 days. Statistical analysis was performed using a linear mixed effects-model and ROC analysis. ROC analysis was used to determine the threshold of anemia, where C-rSO2 critically decreased >2SD below the mean normative value (<55%) in preterm infants. RESULTS In total 253 recordings from 68 infants (mean EGA 26.9 ± 2.1 weeks, BW 1025 ± 287 g, 49% male) were included. Approximately 29 out of 68 infants (43%) were transfused during hospitalization. Mixed-model statistical analysis adjusting for EGA, BW, and PMA revealed a significant association between decreasing hemoglobin and C-rSO2 (p < 0.01) in transfusion-naive infants but not in transfused infants. In the transfusion naive group, using ROC analysis demonstrated a threshold hemoglobin of 9.5 g/dL (AUC 0.81, p < 0.01) for critical cerebral desaturation in preterm infants. CONCLUSIONS In transfusion-naive preterm infants, worsening anemia was associated with a progressive decrease in cerebral saturations. Analysis identified a threshold hemoglobin of 9.5 g/dL below which C-rSO2 dropped >2SD below the mean.
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Affiliation(s)
- Halana V. Whitehead
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
| | - Zachary A. Vesoulis
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
| | - Akhil Maheshwari
- Department of Pediatrics, Division of Neonatology, University of South Florida Morsani College of Medicine
| | - Rakesh Rao
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
| | - Amit M. Mathur
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
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Moore SP, Newberry DM, Jnah AJ. Use of Placental/Umbilical Blood Sampling for Neonatal Admission Blood Cultures: Benefits, Challenges, and Strategies for Implementation. Neonatal Netw 2018; 36:152-159. [PMID: 28494827 DOI: 10.1891/0730-0832.36.3.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Placental blood remains an underused resource for early neonatal care despite ample evidence that placental blood provides the same clinical decision making information without the need for painful, invasive blood sampling procedures. Potential benefits of placental/umbilical blood sampling (PUBS) for neonatal admission labs include decreases in pain reactivity, rates of anemia, need for blood transfusions, use of vasopressors, and rates of intraventricular hemorrhage. Here, we present a unique case study of a critically ill infant with contradictory blood culture results from PUBS and direct infant sampling. A negative admission direct sample blood culture result compared with a positive admission PUBS blood culture result suggests that infection may have been missed in the direct infant sample. Relevant placental embryology and circulation is also described, as well as the benefits of PUBS for neonatal admission labs (with focus on the blood culture), challenges associated with PUBS practice, and strategies for implementation of PUBS.
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26
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Poryo M, Boeckh JC, Gortner L, Zemlin M, Duppré P, Ebrahimi-Fakhari D, Wagenpfeil S, Heckmann M, Mildenberger E, Hilgendorff A, Flemmer AW, Frey G, Meyer S. Ante-, peri- and postnatal factors associated with intraventricular hemorrhage in very premature infants. Early Hum Dev 2018; 116:1-8. [PMID: 29091782 DOI: 10.1016/j.earlhumdev.2017.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) is one of the most serious complications in preterm infants and is associated with neurological sequelae and mortality. Over the past few decades, the rate of IVH has decreased due to improved neonatal intensive care. However, up to 15-25% of very and extremely premature infants (<32 and <28weeks of pregnancy (WOP) respectively) still suffer from IVH. STUDY PURPOSE The aim of this study was to perform an updated, multicenter analysis to identify ante-, peri, and postnatal factors other than gestational age/birth weight associated with IVH of any grade in a large cohort of very and extremely premature infants. METHODS We performed a retrospective analysis in a prospectively conducted multicenter cohort study between 01/01/1998-31/12/2012 at 5 level 3 perinatal centers. All relevant ante-, peri- and neonatal data were collected and univariate as well as multivariate logistic regression analysis was performed. RESULTS 765 inborn infants with a gestational age<32 WOP were enrolled into this study (369 (48.2%) female; 396 (51.8%) male). Birth weight ranged from 315g to 2200g (mean 1149.7g, SD 371.9g); 279 (36.5%) were born ≤27+6 WOP and 486 (63.5%)≥28+0 WOP. IVH was seen in 177 (23.1%) patients. Multivariate analysis revealed that in addition to higher gestational age (OR 0.7, CI [0.6-0.8]), antenatal steroid treatment (OR 0.3, CI [0.2-0.6]) and caesarian section without uterine contraction (OR 0.6, CI [0.4-0.9]) were associated with a lower rate of IVH while RDS (OR 5.6, CI [1.3-24.2]), pneumothorax (OR 2.8, CI [1.4-5.5]) and use of catecholamines (OR 2.7, CI [1.7-4.5]) were associated with an increased risk of IVH. After exclusion of gestational age and birth weight from multivariate analysis, early onset sepsis (OR 1.6, CI [1.01-2.7]) and patent ductus arteriosus (OR 1.9, CI [1.1-3.1]) were associated with a higher rate of IVH. In addition, univariate analysis revealed that Apgar scores at 5min (p<0.001), BDP/ROP/NEC (p<0.001), mechanical ventilation (p<0.001) and inhalative nitric oxide (p<0.001) were significantly associated with IVH. CONCLUSIONS Our comprehensive analysis demonstrated that the occurrence of IVH in very premature infants is significantly associated with ante-, peri- and postnatal factors being either related to the degree of immaturity or indicating a critical clinical course after birth. The analysis reiterates the necessity for a very close cooperation between obstetricians and neonatologists to reduce the incidence of IVH in this susceptible cohort.
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Affiliation(s)
- Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Judith Caroline Boeckh
- Department of Internal Medicine, Katharinenhospital Klinikum Stuttgart, Stuttgart, Germany
| | - Ludwig Gortner
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Zemlin
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Perrine Duppré
- University of Saarland, Medical School, Homburg/Saar, Germany
| | | | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg/Saar, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Germany
| | - Eva Mildenberger
- Department of Neonatology, University Medical Center, Johannes Gutenberg University Mainz, Germany
| | - Anne Hilgendorff
- Department of Neonatology, University Medical Center, Ludwig-Maximilian-University Munich, Germany
| | - Andreas W Flemmer
- Department of Neonatology, University Medical Center, Ludwig-Maximilian-University Munich, Germany
| | - Georg Frey
- Department of Pediatric Cardiology and Neonatology, Darmstaedter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Sascha Meyer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany; Department of Pediatric Neurology, Saarland University Medical Center, Homburg/Saar, Germany
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Elevated fecal calprotectin levels during necrotizing enterocolitis are associated with activated neutrophils extruding neutrophil extracellular traps. J Perinatol 2016; 36:862-9. [PMID: 27388941 PMCID: PMC5045760 DOI: 10.1038/jp.2016.105] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Neonates with necrotizing enterocolitis (NEC) have higher calprotectin levels in stool than do healthy neonates. However, it is not known whether high stool calprotectin at the onset of bowel symptoms identifies neonates who truly have NEC vs other bowel disorders. STUDY DESIGN Neonates were eligible for this study when an x-ray was ordered to 'rule-out NEC'. Stool calprotectin was quantified at that time and in a follow-up stool. Each episode was later categorized as NEC or not NEC. The location of calprotectin in the bowel was determined by immunohistochemistry. RESULTS Neonates with NEC had higher initial and follow-up stool calprotectin levels than did neonates without NEC. Calprotectin in bowel from neonates with NEC was within neutrophil extracellular traps (NETs). CONCLUSION At the onset of signs concerning for NEC, fecal calprotectin is likely to be higher in neonates with NEC. Calprotectin in their stools is exported from neutrophils via NETs.
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Research Opportunities to Improve Neonatal Red Blood Cell Transfusion. Transfus Med Rev 2016; 30:165-73. [PMID: 27424006 DOI: 10.1016/j.tmrv.2016.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/28/2016] [Indexed: 01/23/2023]
Abstract
Red blood cell (RBC) transfusion is a common and lifesaving therapy for anemic neonates and infants, particularly among those born prematurely or undergoing surgery. However, evidence-based indications for when to administer RBCs and adverse effects of RBC transfusion on important outcomes including necrotizing enterocolitis, survival, and long-term neurodevelopmental impairment remain uncertain. In addition, blood-banking practices for preterm and term neonates and infants have been largely developed using studies from older children and adults. Use of and refinements in emerging technologies and advances in biomarker discovery and neonatal-specific RBC transfusion databases may allow clinicians to better define and tailor RBC transfusion needs and practices to individual neonates. Decreasing the need for RBC transfusion and developing neonatal-specific approaches in the preparation of donor RBCs have potential for reducing resource utilization and cost, improving outcomes, and assuring blood safety. Finally, large donor-recipient-linked cohort studies can provide data to better understand the balance of the risks and benefits of RBC transfusion in neonates. These studies may also guide the translation of new research into best practices that can rapidly be integrated into routine care. This review highlights key opportunities in transfusion medicine and neonatology for improving the preparation and transfusion of RBCs into neonates and infants. We focus on timely, currently addressable knowledge gaps that can increase the safety and efficacy of preterm and term neonatal and infant RBC transfusion practices.
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Kalagiri RR, Choudhury S, Carder T, Govande V, Beeram MR, Uddin MN. Neonatal Thrombocytopenia as a Consequence of Maternal Preeclampsia. AJP Rep 2016; 6:e42-7. [PMID: 26929869 PMCID: PMC4737627 DOI: 10.1055/s-0035-1565923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/26/2015] [Indexed: 10/25/2022] Open
Abstract
Introduction Preeclampsia (preE) is pregnancy-induced hypertension affecting a significant proportion of pregnant women worldwide and can cause detrimental effects in the mother and newborn. Some of the effects in the newborn include neonatal thrombocytopenia. Pertaining specifically to neonatal thrombocytopenia, several questions remain unanswered. Discussion According to the current literature, neonatal thrombocytopenia due to maternal preE is highly prevalent in the general population and the incidence is reported to be around 30% worldwide. This review gives an insight into the syndrome and summarizes the possible pathological mechanisms, the diagnostic approach, complications, and therapeutic interventions of neonatal thrombocytopenia. It also identifies the involvement of other cell lines, apart from platelets in the newborns. Furthermore, we suggest a future prospective study to investigate the pathogenesis of preE and plan a study involving animal models to come up with a possible therapeutic intervention to prevent preE and its various consequences in neonates.
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Affiliation(s)
- Ram R Kalagiri
- Department of Neonatology, Baylor Scott & White Healthcare, Temple, Texas; Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Saiara Choudhury
- Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Timothy Carder
- Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Vinayak Govande
- Department of Pediatrics, Baylor Scott & White Healthcare, Temple, Texas
| | - Madhava R Beeram
- Department of Neonatology, Baylor Scott & White Healthcare, Temple, Texas; Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas; Department of Pediatrics, Baylor Scott & White Healthcare, Temple, Texas
| | - M Nasir Uddin
- Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas; Department of Pediatrics, Baylor Scott & White Healthcare, Temple, Texas; Departments of Obstetrics & Gynecology, Baylor Scott & White Healthcare, Temple, Texas; Department of Internal Medicine, Baylor Scott & White Healthcare, Temple, Texas
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Abstract
Neonatal anemia is a frequent occurrence in neonatal intensive care units. Red blood cell transfusion criteria in case of blood loss are clearly defined but optimal hemoglobin or hematocrit thresholds of transfusion for anemia due to decreased production or increased destruction are less evident. This review focuses on the causes of anemia in the newborn period and the most recent evidence-based treatment options, including transfusion and erythropoiesis-stimulating agents.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera - University of Padova, Padova, Italy.
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera - University of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Neonatology Intensive Care Unit, Department of Child and Maternal Health, Azienda Ospedaliera - University of Padova, Padova, Italy
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Rabe H, Sawyer A, Amess P, Ayers S. Neurodevelopmental Outcomes at 2 and 3.5 Years for Very Preterm Babies Enrolled in a Randomized Trial of Milking the Umbilical Cord versus Delayed Cord Clamping. Neonatology 2016; 109:113-9. [PMID: 26650133 DOI: 10.1159/000441891] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/21/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Guidelines published by the International Liaison Committee for Resuscitation and by the World Health Organization recommend delaying cord clamping at birth as part of routine care for infants. OBJECTIVE To study the use of milking of the cord 4 times as an alternative to enhance the redistribution of placental blood into the baby. METHODS This is a prospective cohort study of neurodevelopmental assessment by the Bayley III method of very preterm infants who had participated in a trial of delayed cord clamping versus cord milking at birth that was conducted in a neonatal tertiary care hospital. The primary outcomes were differences in cognitive, motor and language development at 2 and 3.5 years. Two-tailed analyses were performed with the x03C7;2 test, Fisher's exact test, t test, Mann-Whitney U test and ANCOVA. RESULTS Out of the 58 infants enrolled in the original study, 39 infants (67%) were assessed at 2 years and 29 (50%) at 3.5 years of age. Neurodevelopmental outcomes at 2 and 3.5 years did not significantly differ between the two groups for the three Bayley III composite scores. At 3.5 years there was a trend towards higher scores for girls in the language composite scores (girls: mean = 121.6, SD = 15.22; boys: mean = 101.07, SD = 19.84) and on the motor scale (girls: mean = 124.60, SD = 18.15; boys: mean = 97.86, SD = 17.23). CONCLUSIONS In this small number of participants followed up at 2 and 3.5 years of age, milking of the cord 4 times did not have any long-term adverse effect on neurodevelopmental outcome, suggesting that cord milking could be used as an alternative to delayed cord clamping.
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Affiliation(s)
- Heike Rabe
- Academic Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
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Duppré P, Sauer H, Giannopoulou EZ, Gortner L, Nunold H, Wagenpfeil S, Geisel J, Stephan B, Meyer S. Cellular and humoral coagulation profiles and occurrence of IVH in VLBW and ELWB infants. Early Hum Dev 2015; 91:695-700. [PMID: 26529174 DOI: 10.1016/j.earlhumdev.2015.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 08/05/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND STUDY PURPOSE Intraventricular hemorrhage (IVH) is a major complication in preterm neonates with significant long-term morbidity and an increased mortality rate. The role of the immature coagulation system in the pathogenesis of IVH in these infants is still under debate. The aim of this study was to provide reference values for coagulation studies within the first 24h of life, and to relate these findings to the incidence of IVH. PATIENTS AND METHODS In this retrospective study, a total of 250 (male: 123/female: 127; VLBW: 150 and ELBW: 100) infants were included over a 4-year-period. Coagulation studies were performed within the first 24h of life in all infants. Multiple regression analysis was employed to demonstrate a potential association between IVH and a number of known risk and protective factors for IVH (antenatal steroids, birth weight, gender, IUGR, APGAR score at 10minutes, platelet count, INR, PTT, fibrinogen). RESULTS Mean birth weight was 1047.9±305.6 (range: 320-1490g). Both cellular (platelets, nucleated red blood cells) and plasmatic coagulation parameters (INR, fibrinogen and antithrombin III) were dependent on birth weight. Moreover, INR levels (p<0.05) were significantly increased in neonates with IVH of any grade. Also, INR was positively correlated with the severity of IVH (Spearman's correlation coefficient: 0.193; p=0.003). While overall fibrinogen levels were not associated with IVH, a fibrinogen level<100mg/dL significantly increased the risk for IVH (p<0.01). CONCLUSIONS Our data provide a robust set of reference values for both cellular and humoral coagulation studies in VLBW and ELBW infants for the first 24h of life. The results of our study indicate that abnormal INR levels and fibrinogen levels<100mg/dL are significantly associated with the occurrence of IVH in this susceptible cohort.
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Affiliation(s)
- Perrine Duppré
- University Hospital of Saarland, Medical School, Germany
| | - Harald Sauer
- University Children's Hospital of Saarland, Department of Pediatric Cardiology, Germany
| | - Eleni Z Giannopoulou
- University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany
| | - Ludwig Gortner
- University Hospital of Saarland, Medical School, Germany; University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany
| | - Holger Nunold
- University Children's Hospital of Saarland, Department of Pediatrics, Germany
| | - Stefan Wagenpfeil
- University Hospital of Saarland, Institute of Medical Biometry, Epidemiology, and Medical Informatics, Germany
| | - Jürgen Geisel
- University Hospital of Saarland, Clinical Chemistry and Laboratory Diagnostics, Germany
| | - Bernhard Stephan
- University Hospital of Saarland, Department of Clinical Hemostaseology, Germany
| | - Sascha Meyer
- University Hospital of Saarland, Medical School, Germany; University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany.
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Abstract
There is significant world-wide variability in platelet transfusion thresholds used to transfuse thrombocytopenic neonates. A large multicenter randomized controlled trial comparing 2 different platelet transfusion thresholds in neonates is currently ongoing, and should provide data to guide transfusion practice. However, several studies have found that factors other than the degree of thrombocytopenia determine the bleeding risk. Thus, it will be important to develop better tests to assess primary hemostasis and bleeding risk in neonates.
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Ohls RK, Christensen RD, Widness JA, Juul SE. Erythropoiesis Stimulating Agents Demonstrate Safety and Show Promise as Neuroprotective Agents in Neonates. J Pediatr 2015; 167:10-2. [PMID: 25917767 PMCID: PMC4795451 DOI: 10.1016/j.jpeds.2015.03.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/31/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico.
| | - Robert D Christensen
- Divisions of Neonatology and Hematology Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - John A Widness
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
| | - Sandra E Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington
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Gluckman E. Umbilical cord blood transfusions in low-income countries. LANCET HAEMATOLOGY 2015; 2:e85-6. [DOI: 10.1016/s2352-3026(15)00019-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
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Henry E, Christensen RD, Sheffield MJ, Eggert LD, Carroll PD, Minton SD, Lambert DK, Ilstrup SJ. Why do four NICUs using identical RBC transfusion guidelines have different gestational age-adjusted RBC transfusion rates? J Perinatol 2015; 35:132-6. [PMID: 25254330 DOI: 10.1038/jp.2014.171] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 07/29/2014] [Accepted: 08/04/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare neonatal red blood cell (RBC) transfusion rates in four large Intermountain Healthcare NICUs, all of which adhere to the same RBC transfusion guidelines. STUDY DESIGN This retrospective analysis was part of a transfusion-management quality-improvement project. De-identified data included RBC transfusions, clinical and laboratory findings, the anemia-prevention strategies in place in each NICU, and specific costs and outcomes. RESULT Of 2389 NICU RBC transfusions given during the 4-year period studied, 98.9 ± 2.1% (mean ± S.D.) were compliant with our transfusion guidelines, with no difference in compliance between any of the four NICUs. However, RBC transfusion rates varied widely between the four, with averages ranging from 4.6 transfusions/1000 NICU days to 21.7/1000 NICU days (P < 0.00001). Gestational age-adjusted transfusion rates were correspondingly discordant (P < 0.00001). The lower-transfusing NICUs had written anemia-preventing guidelines, such as umbilical cord milking at very low birth weight delivery, use of cord blood for admission laboratory studies, and darbepoetin dosing for selected neonates. Rates of Bell stage ⩾ 2 necrotizing enterocolitis and grade ⩾ 3 intraventricular hemorrhage were lowest in the two lower-transfusing NICUs (P < 0.0002 and P < 0.0016). Average pharmacy costs for darbepoetin were $84/dose, with an average pharmacy cost of $269 per transfusion averted. With a cost of $900/RBC transfusion, the anemia-preventing strategies resulted in an estimated cost savings to Intermountain Healthcare of about $6970 per 1000 NICU days, or about $282,300 annually. CONCLUSION Using transfusion guidelines has been shown previously to reduce practice variability, lower transfusion rates and diminish transfusion costs. Based on our present findings, we maintain that even when transfusion guidelines are in place and adhered to rigorously, RBC transfusion rates are reduced further if anemia-preventing strategies are also in place.
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Affiliation(s)
- E Henry
- The Women and Newborn's Clinical Program, Salt Lake City, UT, USA
| | - R D Christensen
- The Women and Newborn's Clinical Program, Salt Lake City, UT, USA
| | - M J Sheffield
- The Women and Newborn's Clinical Program, Salt Lake City, UT, USA
| | - L D Eggert
- The Women and Newborn's Clinical Program, Salt Lake City, UT, USA
| | - P D Carroll
- The Women and Newborn's Clinical Program, Salt Lake City, UT, USA
| | - S D Minton
- The Women and Newborn's Clinical Program, Salt Lake City, UT, USA
| | - D K Lambert
- The Women and Newborn's Clinical Program, Salt Lake City, UT, USA
| | - S J Ilstrup
- The Transfusion Medicine Program, Intermountain Healthcare, Salt Lake City, UT, USA
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Carr R, Kelly AM, Williamson LM. Neonatal thrombocytopenia and platelet transfusion - a UK perspective. Neonatology 2015; 107:1-7. [PMID: 25301082 DOI: 10.1159/000365163] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Five percent of newborn infants admitted to UK neonatal units during a recent study developed a platelet count <60 × 10(9)/l, and 60% of these were transfused platelets. This review summarises the common causes and mechanisms of thrombocytopenia in the newborn. Relevant evidence relating the platelet count to the risk of haemorrhage is reviewed, and current UK guidance on transfusion thresholds outlined. The UK policy for the provision of platelets for transfusion to neonates is described, including the particular requirements for neonatal allo-immune thrombocytopenia. Finally, we look towards the future and prospects for reducing the need to expose newborns to donor-derived platelets.
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Affiliation(s)
- Robert Carr
- Department of Haematology, Guy's and St Thomas' Hospital, King's College London, London, UK
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Kaur A, Dhir SK, Kaur G, Gupta M, Batta M. Blood component therapy in neonates in a neonatal intensive care unit of northern India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2015. [DOI: 10.1016/j.cegh.2015.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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