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Miran AA, Stoopler M, Cizmeci MN, El Shahed A, Yankanah R, Danguecan A, Ly L, Signorile M, Runeckles K, Fan CPS, Kalish BT. Blood product transfusion practices in neonates with hypoxic-ischemic encephalopathy. J Perinatol 2024; 44:1485-1490. [PMID: 39147790 DOI: 10.1038/s41372-024-02092-1] [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: 03/12/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Blood product transfusion is a common practice in infants with hypoxic-ischemic encephalopathy (HIE) undoing therapeutic hypothermia (TH). The advantages and disadvantages of conservative or liberal transfusion practices in this fragile population are unknown. Study aims to characterize the transfusion practices in infants with HIE and investigate the association with outcome. STUDY DESIGN We conducted a retrospective cohort study at a single level IV NICU, evaluating transfusion thresholds, as well as the association between hematological abnormalities or blood product transfusions and outcomes in infants admitted with HIE. RESULT By univariate analysis, FFP transfusion was associated with increased in-hospital death. However, multivariate analysis adjusting for HIE severity demonstrated no association between hematological abnormality or blood product transfusion and death, nor with neurodevelopmental impairment. CONCLUSION No association was found between hematological blood product transfusion and death or neurodevelopmental impairment in a retrospective single NICU study of infants with HIE.
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Affiliation(s)
- Atiyeh A Miran
- Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Michelle Stoopler
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Mehmet Nevzat Cizmeci
- Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Amr El Shahed
- Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Rosanna Yankanah
- Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Ashley Danguecan
- Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Linh Ly
- Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Marisa Signorile
- Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Kyle Runeckles
- Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Brian T Kalish
- Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada.
- Program in Neuroscience and Mental Health, SickKids Research Institute, Toronto, ON, M5G 1L7, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, ON, M5G 1A8, Canada.
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Limratana P, Maisat W, Tsai A, Yuki K. Perioperative Factors and Radiographic Severity Scores for Predicting the Duration of Mechanical Ventilation After Arterial Switch Surgery. J Cardiothorac Vasc Anesth 2024; 38:992-1005. [PMID: 38365467 PMCID: PMC10947876 DOI: 10.1053/j.jvca.2024.01.011] [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: 10/22/2023] [Revised: 12/26/2023] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Cardiac surgery on cardiopulmonary bypass (CPB) during the neonatal period can cause perioperative organ injuries. The primary aim of this study was to determine the incidence and risk factors associated with postoperative mechanical ventilation duration and acute lung injury after the arterial switch operation (ASO). The secondary aim was to examine the utility of the Brixia score for characterizing postoperative acute lung injury (ALI). DESIGN A retrospective study. SETTING A single-center university hospital. PARTICIPANTS A total of 93 neonates with transposition of great arteries with intact ventricular septum (dTGA IVS) underwent ASO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS From January 2015 to December 2022, 93 neonates with dTGA IVS were included in the study. The cohort had a median age of 4.0 (3.0-5.0) days and a mean weight of 3.3 ± 0.5 kg. About 63% of patients had ≥48 hours of postoperative mechanical ventilation after ASO. Risk factors included prematurity, post-CPB transfusion of salvaged red cells, platelets and cryoprecipitate, and postoperative fluid balance by univariate analysis. The larger transfused platelet volume was associated with the risk of ALI by multivariate analysis. The median baseline Brixia scores were 11.0 (9.0-12.0) and increased significantly in the postoperative day 1 in patients who developed moderate ALI 24 hours after admission to the intensive care unit (15.0 [13.0-16.0] v 12.0 [10.0-14.0], p = 0.046). CONCLUSIONS Arterial switch operation results in a high incidence of ≥48-hour postoperative mechanical ventilation. Blood component transfusion is a potentially modifiable risk factor. The Brixia scores also may be used to characterize postoperative acute lung injury.
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Affiliation(s)
- Panop Limratana
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wiriya Maisat
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andy Tsai
- Department of Radiology, Boston Children’s Hospital, Boston, MA, USA
| | - Koichi Yuki
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
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Bahr TM, Snow GL, Christensen TR, Davenport P, Henry E, Tweddell SM, Ilstrup SJ, Yoder BA, Ohls RK, Sola-Visner MC, Christensen RD. Can Red Blood Cell and Platelet Transfusions Have a Pathogenic Role in Bronchopulmonary Dysplasia? J Pediatr 2024; 265:113836. [PMID: 37992802 DOI: 10.1016/j.jpeds.2023.113836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To evaluate whether transfusions in infants born preterm contribute to the pathogenesis of bronchopulmonary dysplasia (BPD). STUDY DESIGN We conducted a multihospital, retrospective study seeking associations between red blood cell or platelet transfusions and BPD. We tabulated all transfusions administered from January 2018 through December 2022 to infants born ≤29 weeks or <1000 g until 36 weeks postmenstrual age and compared those with BPD grade. We performed a sensitivity analysis to assess the possibility of a causal relationship. We then determined whether each transfusion was compliant with restrictive guidelines, and we estimated effects fewer transfusions might have on future BPD incidence. RESULTS Eighty-four infants did not develop BPD and 595 did; 352 developed grade 1 (mild), 193 grade 2 (moderate), and 50 grade 3 (severe). Transfusions were given at <36 weeks to 7% of those who did not develop BPD, 46% who did, and 98% who developed severe BPD. For every transfusion the odds of developing BPD increased by a factor of 2.27 (95% CI, 1.59-3.68; P < .001). Sensitivity analyses suggested that transfusions might contribute to BPD. Fifty-seven percent of red blood cell transfusions and 68% of platelet transfusions were noncompliant with new restrictive guidelines. Modeling predicted that complying with restrictive guidelines could reduce the transfusion rate by 20%-30% and the moderate to severe BPD rate by ∼4%-6%. CONCLUSIONS Transfusions were associated with BPD incidence and severity. Lowering transfusion rates to comply with current restrictive guidelines might result in a small but meaningful reduction in BPD rates.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT; Department of Neonatology, Intermountain Health, Murray, UT.
| | | | - Thomas R Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Patricia Davenport
- Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Erick Henry
- Department of Neonatology, Intermountain Health, Murray, UT
| | - Sarah M Tweddell
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Sarah J Ilstrup
- Transfusion Services and Department of Pathology, Intermountain Health, Murray, UT
| | - Bradley A Yoder
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Martha C Sola-Visner
- Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT; Department of Neonatology, Intermountain Health, Murray, UT
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