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Gezmu AM, Tefera E, Mochankana K, Imran F, Joel D, Pelaelo I, Nakstad B. Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana. Front Pediatr 2023; 11:1171223. [PMID: 37388284 PMCID: PMC10306393 DOI: 10.3389/fped.2023.1171223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Pulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting. Methods and materials A cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X2 and Student's t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage. Result There were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%-5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage. Conclusion This cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.
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Affiliation(s)
| | - Endale Tefera
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Kagiso Mochankana
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Fizzah Imran
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Irene Pelaelo
- Department of Paediatrics, Princess Marina Hospital Botswana MOH, Gaborone, Botswana
| | - Britt Nakstad
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
- Division of Paediatric and Adolescent Medicine, Inst Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Li J, Xia H, Ye L, Li X, Zhang Z. Exploring prediction model and survival strategies for pulmonary hemorrhage in premature infants: a single-center, retrospective study. Transl Pediatr 2021; 10:1324-1332. [PMID: 34189090 PMCID: PMC8193000 DOI: 10.21037/tp-21-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pulmonary hemorrhage is a potentially fatal event especially for preterm infants, which can lead to serious complications and even death. Many risk factors have been associated with the development of massive pulmonary hemorrhage. However, there is still no effective strategy to prevent massive pulmonary hemorrhage. The purpose of this study is to explore prediction model and survival strategies for massive pulmonary hemorrhage in premature infants. METHODS In this retrospective study, we included all premature infants with birth weight <1,500 g who were hospitalized in our neonatal intensive care unit (NICU) between January 01 2010 and December 31 2019. RESULTS Of 599 preterm infants, 51 developed massive pulmonary hemorrhage. The logistic regression analysis showed that patent ductus arteriosus [odds ratio (OR) =11.4, 95% confidence interval (CI): 4.79-27.0, P<0.0001], coagulopathy (OR =6.56, 95% CI: 2.83-15.2, P<0.0001), and 10-minute Apgar Score (OR =0.52, 95% CI: 0.37-0.73, P=0.0001) were risk factors for massive pulmonary hemorrhage. Whether or not surfactant is used, the positive predictive value of combined patent ductus arteriosus and coagulopathy for predicting massive pulmonary hemorrhage was 68.9% and 70.4%, respectively. Of the 51 preterm infants with massive pulmonary hemorrhage, 25 died and 26 survived. The survivors group had higher positive end-expiratory pressure compared with the deceased group after the onset of massive pulmonary hemorrhage. After adjusting for potential risk factors, the multiple logistic regression analysis showed that higher positive end-expiratory pressure levels are closely related to survival. CONCLUSIONS Patent ductus arteriosus combined with coagulopathy has a high predictive value for massive pulmonary hemorrhage. Higher positive end-expiratory pressure levels may reduce mortality in massive pulmonary hemorrhage.
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Affiliation(s)
- Jing Li
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hejie Xia
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Ye
- Department of Neonatology, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, China
| | - Xiaoxia Li
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqun Zhang
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Adult Donor Blood Products as Risk Factors for Central Venous Catheter-associated Thromboembolism in Neonates: A Retrospective Case-Control Study. J Pediatr Hematol Oncol 2021; 43:e255-e259. [PMID: 32459720 DOI: 10.1097/mph.0000000000001821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
Abstract
This study aimed to examine whether the transfusion of donor blood products, abnormal coagulation or inflammation increase the risk of venous thromboembolism (VTE) associated with central venous catheters (CVC) in neonates. A retrospective case-control study including 25 neonates with CVC-associated VTE and tightly matched controls with CVC, but without VTE was performed. The frequency of (i) abnormal coagulation screens, (ii) increased inflammatory marker proteins before catheter insertion, or (iii) catheter-associated blood stream infection did not differ between cases and controls. No difference was found in the number or type of transfusions within the last day before VTE. However, the total number of transfusions in the time period between catheter placement and VTE diagnosis (median 6.5 d) was significantly higher (P<0.001) in cases (44 red blood cell, 61 plasma, and 18 platelet transfusions) compared with an equal median time period of 7 days postcatheter insertion in controls (26/24/11). In conclusion, intensive transfusion treatment (through a peripheral line) after CVC insertion was associated with a higher risk of VTE (odds ratio 7.58; 95% confidence interval, 0.84-68.46), suggesting that transfusion of adult donor blood products into the cellular and plasmatic hemostatic system of the neonate increases the risk for CVC-associated VTE.
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Reibel NJ, Dame C, Bührer C, Muehlbacher T. Aberrant Hematopoiesis and Morbidity in Extremely Preterm Infants With Intrauterine Growth Restriction. Front Pediatr 2021; 9:728607. [PMID: 34869097 PMCID: PMC8633541 DOI: 10.3389/fped.2021.728607] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022] Open
Abstract
Background and Objective: Intrauterine growth restriction (IUGR) poses additional challenges in extremely low gestational age newborns (ELGANs). We assessed disturbed hematopoiesis and morbidities associated with this disorder. Methods: This single-center retrospective case-control study compared perinatal hematological profiles, major morbidities, and mortality of 49 infants (gestational age <28 weeks, birth weight ≤ 3rd percentile, and compromised placental function) and 98 infants (birth weight >10th percentile) matched for gestational age, year, and sex. Results: IUGR-ELGANs had significantly elevated nucleated red blood cells and lower neutrophil and platelet counts at birth and on the third day of life. During the first week of life, IUGR-ELGANs received more red blood cell, platelet, and plasma transfusions and were more intensively treated with antibiotics. Rates of infections acquired during the first week (59.2 vs. 17.3%, p < 0.001), severe bronchopulmonary dysplasia or death (42.9 vs. 17.3%, p < 0.01), and mortality (36.7 vs. 7.1%, p < 0.001) were markedly elevated in IUGR-ELGANs, but not of hemorrhages or other morbidities. Conclusions: IUGR-ELGANs have high rates of acquired infections during the first week of life and display severe pulmonary morbidity leading to bronchopulmonary dysplasia or death. The high rate of transfusions observed in these infants warrants further scrutiny.
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Affiliation(s)
- Nora J Reibel
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christof Dame
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Muehlbacher
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
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5
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Kim JS, Kim JY. Neonatal Thrombocytopenia: Diagnostic Approach and Platelet Transfusion Guideline. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2019. [DOI: 10.15264/cpho.2019.26.2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji Sook Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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Fustolo-Gunnink SF, Fijnvandraat K, Putter H, Ree IM, Caram-Deelder C, Andriessen P, d'Haens EJ, Hulzebos CV, Onland W, Kroon AA, Vijlbrief DC, Lopriore E, van der Bom JG. Dynamic prediction of bleeding risk in thrombocytopenic preterm neonates. Haematologica 2019; 104:2300-2306. [PMID: 30819913 PMCID: PMC6821634 DOI: 10.3324/haematol.2018.208595] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/27/2019] [Indexed: 11/22/2022] Open
Abstract
Over 75% of severely thrombocytopenic neonates receive platelet transfusions, though little evidence supports this practice, and only 10% develop major bleeding. In a recent randomized trial, giving platelet transfusions at a threshold platelet count of 50x109/L compared to a threshold of 25x109/L was associated with an increased risk of major bleeding or mortality. This finding highlights the need for improved and individualized guidelines on neonatal platelet transfusion, which require accurate prediction of bleeding risk. Therefore, the objective of this study was to develop a dynamic prediction model for major bleeding in thrombocytopenic preterm neonates. This model allows for calculation of bleeding risk at any time-point during the first week after the onset of severe thrombocytopenia. In this multicenter cohort study, we included neonates with a gestational age <34 weeks, admitted to a neonatal intensive care unit, who developed severe thrombocytopenia (platelet count <50x109/L). The study endpoint was major bleeding. We obtained predictions of bleeding risk using a proportional baselines landmark supermodel. Of 640 included neonates, 71 (11%) had a major bleed. We included the variables gestational age, postnatal age, intrauterine growth retardation, necrotizing enterocolitis, sepsis, platelet count and mechanical ventilation in the model. The median cross-validated c-index was 0.74 (interquartile range, 0.69-0.82). This is a promising dynamic prediction model for bleeding in this population that should be explored further in clinical studies as a potential instrument for supporting clinical decisions. The study was registered at www.clinicaltrials.gov (NCT03110887).
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Affiliation(s)
- Susanna F Fustolo-Gunnink
- Sanquin/LUMC, Center for Clinical Transfusion Research, Leiden.,Amsterdam University Medical Center, Emma Children's Hospital, Department of Pediatric Hematology, Amsterdam-Zuidoost
| | - Karin Fijnvandraat
- Amsterdam University Medical Center, Emma Children's Hospital, Department of Pediatric Hematology, Amsterdam-Zuidoost.,Sanquin Blood Supply Foundation, Department of Plasma Proteins, Sanquin Research, Amsterdam
| | - Hein Putter
- Leiden University Medical Center, Department of Medical Statistics, Leiden
| | - Isabelle M Ree
- Leiden University Medical Center, Willem Alexander Children's Hospital, Department of Neonatology, Leiden
| | | | | | - Esther J d'Haens
- Isala Zwolle, Amalia Children's Center, Department of Neonatology, Zwolle
| | - Christian V Hulzebos
- University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen
| | - Wes Onland
- Amsterdam University Medical Center, Emma Children's Hospital, Department of Neonatology, Amsterdam-Zuidoost
| | - André A Kroon
- Erasmus Medical Center, Sophia Children's Hospital, Department of Neonatology, Rotterdam
| | - Daniël C Vijlbrief
- University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht
| | - Enrico Lopriore
- Leiden University Medical Center, Willem Alexander Children's Hospital, Department of Neonatology, Leiden
| | - Johanna G van der Bom
- Sanquin/LUMC, Center for Clinical Transfusion Research, Leiden .,Amsterdam University Medical Center, Emma Children's Hospital, Department of Pediatric Hematology, Amsterdam-Zuidoost.,Sanquin Blood Supply Foundation, Department of Plasma Proteins, Sanquin Research, Amsterdam.,Leiden University Medical Center, Department of Medical Statistics, Leiden.,Leiden University Medical Center, Willem Alexander Children's Hospital, Department of Neonatology, Leiden.,Máxima Medical Center, Department of Neonatology, Veldhoven.,Isala Zwolle, Amalia Children's Center, Department of Neonatology, Zwolle.,University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen.,Amsterdam University Medical Center, Emma Children's Hospital, Department of Neonatology, Amsterdam-Zuidoost.,Erasmus Medical Center, Sophia Children's Hospital, Department of Neonatology, Rotterdam.,University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht.,Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands
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7
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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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8
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Fustolo-Gunnink SF, Huisman EJ, van der Bom JG, van Hout FMA, Makineli S, Lopriore E, Fijnvandraat K. Are thrombocytopenia and platelet transfusions associated with major bleeding in preterm neonates? A systematic review. Blood Rev 2018; 36:1-9. [PMID: 30318111 DOI: 10.1016/j.blre.2018.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/07/2018] [Indexed: 11/16/2022]
Abstract
Over 75% of severely thrombocytopenic preterm neonates receive platelet transfusions to prevent bleeding, but transfusion guidelines are based mainly on expert opinion. The aim of this review was to investigate whether platelet counts, platelet transfusions or platelet indices are associated with major bleeding in preterm neonates. We performed a systematic search of the EMBASE and MEDLINE databases until December 2017. We included randomized trials, cohort and case control studies. (Prospero: CRD42015013399). We screened 8734 abstracts and 1225 fulltexts, identifying 36 eligible studies. In 30, timing of the platelet counts or transfusions in relation to the bleeding was unclear. Of the remaining six studies, two showed that thrombocytopenia was associated with increased risk of bleeding, two showed no such assocation, and three showed lack of an association between platelet transfusions and bleeding risk. No studies assessing platelet indices were found. The study results suggest that prophylactic platelet transfusions may not reduce bleeding risk in preterm neonates.
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Affiliation(s)
- S F Fustolo-Gunnink
- Sanquin blood supply foundation, Department of clinical transfusion medicine, Plesmanlaan 1A, 2333 BZ Leiden, the Netherlands; Amsterdam University Medical Center, Emma Children's Hospital, Department of pediatric hematology, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - E J Huisman
- Erasmus Medical Center, Sophia Children's hospital, Department of pediatric hematology, Wytemaweg 80, 3015 CN Rotterdam, the Netherlands.
| | - J G van der Bom
- Sanquin blood supply foundation, Department of clinical transfusion medicine, Plesmanlaan 1A, 2333 BZ Leiden, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - F M A van Hout
- Sanquin blood supply foundation, Department of clinical transfusion medicine, Plesmanlaan 1A, 2333 BZ Leiden, the Netherlands.
| | - S Makineli
- Amsterdam University Medical Center, Emma Children's Hospital, Department of pediatric hematology, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands.
| | - E Lopriore
- Leiden University Medical Center, Willem Alexander Children's hospital, Department of neonatology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - K Fijnvandraat
- Amsterdam University Medical Center, Emma Children's Hospital, Department of pediatric hematology, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands.
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