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Christensen RD, Bahr TM, Christensen TR, Ohls RK, Krong J, Carlton LC, Henry E, Sheffield MJ, Gerday E, Ilstrup SJ, Kelley WE. Banked term umbilical cord blood to meet the packed red blood cell transfusion needs of extremely-low-gestational-age neonates: a feasibility analysis. J Perinatol 2024; 44:873-879. [PMID: 38030793 DOI: 10.1038/s41372-023-01833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To assess the feasibility of drawing, processing, safety-testing, and banking term umbilical cord blood to meet the packed red blood cell transfusion (RBC Tx) needs of extremely-low-gestational-age neonates (ELGANs). DESIGN (1) Retrospectively analyze all ELGANs RBC Tx over the past three years, (2) Estimate local cord blood availability, (3) Assess interest in this project, and implementation barriers, through stakeholder surveys. RESULTS In three years we cared for 266 ELGANs; 165 (62%) received ≥1 RBC Tx. Annual RBC Tx averaged 197 (95% CI, 152-243). If 10% of our 10,353 annual term births had cord blood drawn and processed, and half of those tested were acceptable for Tx, collections would exceed the 95th % upper estimate for need by >four-fold. Interest exceeded 97%. Identified barriers included FDA approval, training to collect cord blood, and cost. CONCLUSION RBC Tx needs of ELGANS could be met by local cord blood collection.
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Affiliation(s)
- Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA.
- Clinical Research, Intermountain Health, Murray, UT, USA.
| | - Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | | | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jake Krong
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | - Lindsey C Carlton
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
- Clinical Research, Intermountain Health, Murray, UT, USA
| | - Erick Henry
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Mark J Sheffield
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Erick Gerday
- Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA
| | - Sarah J Ilstrup
- Transfusion Services and Department of Pathology, Intermountain Health, Murray, UT, USA
| | - Walter E Kelley
- American National Red Cross, Salt Lake City, UT, USA
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
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Bolat F, Dursun M, Sarıaydın M. Packed Red Blood Cell Transfusion as a Predictor of Moderate-Severe Bronchopulmonary Dysplasia: A Comparative Cohort Study of Very Preterm Infants. Am J Perinatol 2024; 41:e1499-e1507. [PMID: 36898407 DOI: 10.1055/a-2051-8245] [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] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Bronchopulmonary dysplasia (BPD) is a leading cause of morbidity and mortality in neonatal intensive care units. Our aim was to evaluate association between packed red blood cell transfusion and the development of BPD in very preterm infants. STUDY DESIGN This retrospective study of very preterm infants (mean gestational age: 27.1 ± 2.4 weeks, birth weight: 970 ± 271 g) was conducted at Biruni University (Turkey) between July 2016 and December 2020. RESULTS BPD developed in 107 of the 246 enrolled neonates, including 47 (43.9%), 27 (25.3%), and 33 (30.8%) diagnosed with mild, moderate, and severe BPD, respectively. A total of 728 transfusions were administered. The increased number (4 transfusions [2-7] vs. 1 [1-3], p = 0.001) and volume of transfusions (75 mL/kg volume [40-130] vs. 20 [15-43], p = 0.001) were significantly higher in infants with BPD compared to those without BPD. The transfusion volume cut-off for the prediction of BPD by receiver operating characteristic curve analysis was 42 mL/kg (sensitivity 73.6%; specificity 75%; area under the receiver-operating characteristic curve: 0.82). In multivariate analysis, multiple transfusions and larger transfusion volume were independent risk factors for moderate-severe BPD. CONCLUSION The increased number and volume of transfusions were associated with BPD in very preterm infants. A packed red blood cell transfusion volume ≥42 mL/kg was a statistically significant predictor of the development of BPD at a postmenstrual age of 36 weeks. KEY POINTS · Transfusions were found to be an important risk factor for BPD development in very premature infants.. · Number and volume of transfusion were associated with the severity of BPD.. · Optimal cut point volume of transfusion for prediction of BPD was 42 mL/kg body weight..
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Affiliation(s)
- Fatih Bolat
- Division of Neonatology, Department of Pediatrics, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Mesut Dursun
- Division of Neonatology, Department of Pediatrics, Biruni University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sarıaydın
- Division of Neonatology, Department of Pediatrics, Biruni University Faculty of Medicine, Istanbul, Turkey
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Tang L, Zhu TT, Zhao J. Association between red blood cell transfusion and bronchopulmonary dysplasia: a systematic review and meta-analysis. Front Pediatr 2023; 11:1095889. [PMID: 37325359 PMCID: PMC10266411 DOI: 10.3389/fped.2023.1095889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/21/2023] [Indexed: 06/17/2023] Open
Abstract
Background We aimed to determine the association between red blood cell transfusions (RBCT) and bronchopulmonary dysplasia (BPD) in neonates. Methods A systematic review and meta-analysis were conducted using data obtained from literature search of PubMed, Embase, and Web of Science from their inception till May 1, 2022. Two reviewers independently selected potentially relevant studies, and after data extraction, they assessed the methodological quality of the included studies using the Newcastle-Ottawa scale. Data were pooled using random-effects models in Review Manager 5.3. Subgroup-analysis was performed based on the number of transfusions and adjusted results. Results Of the 1,011 identified records, 21 total case-control, cross-sectional, and cohort studies were selected, which included a total of 6,567 healthy controls and 1,476 patients with BPD. The pooled unadjusted odds ratio ([OR], 4.01; 95% confidence interval [CI] 2.31-6.97) and adjusted OR (5.11; 95% CI 3.11-8.4) showed significant association between RBCT and BPD. A substantial heterogeneity was noted, which could be due to different variables controlled for in each study. The subgroup analysis showed that heterogeneity may be partially explained by the extent of transfusion. Conclusion The association between BPD and RBCT remains unclear based on the current data due to the substantial heterogeneity among the results. Well-designed studies are still needed in the future.
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Affiliation(s)
- Li Tang
- Department of Pediatrics Hematology and Oncology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Ting Ting Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Jing Zhao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
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Noor MS, Elbarbary M, Embabi SN, Zaki MA, Awad H, Al-Feky M. Screening and Risk Factors for Retinopathy of Prematurity in a Tertiary Care Hospital in Cairo, Egypt. Clin Ophthalmol 2022; 16:3257-3267. [PMID: 36211718 PMCID: PMC9533779 DOI: 10.2147/opth.s383493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the retinopathy of prematurity (ROP) prevalence, risk factors and screening outcome in a tertiary hospital in Cairo, Egypt. Methods A prospective observational study was done in Neonatal Intensive Care Unit in Ain Shams University Hospital. A total of 159 premature infants were screened for ROP based on the most inclusive criteria reported to date. Screening included premature infants with gestational age (GA) of ≤34 weeks or birth weight (BW) of ≤2000 grams, or GA >34 weeks or BW >2000 grams, with multiple co-morbidities. The prevalence of ROP, plus disease and their correlation with risk factors of interest were studied. Results The GA of the included infants ranged from 27 to 36 weeks, mean (SD) 31.87 (± 1.81) weeks. The BW ranged from 640 to 3900 grams, mean (SD) 1784.71 (± 560.30) grams. The prevalence of ROP more than stage 0 was 25.8% (41 infants), 7.3% of the cases (11 infants) showed plus disease and 6.3% (10 infants) showed severe ROP requiring treatment. Of those, 2 cases (20%) fell outside the British Guideline's criteria for Screening. There was a highly significant (p < 0.0001) correlation between ROP more than stage 0 and low GA, low BW, mechanical ventilation, respiratory distress syndrome, necrotizing enterocolitis, intraventricular haemorrhage, and blood transfusion. No significant correlation was found between appearance of ROP more than stage 0 and gender (p = 0.911), patent ductus arteriosus (p =0.187), or sepsis (p =0.998). Conclusion ROP is a significant problem in the premature infants in Egypt. Extremely premature infants with lower BW are more prone to develop ROP. However, cases with higher GA and BW than mentioned in the British guidelines screening criteria especially with multiple comorbidities showed severe ROP requiring intervention, which implies the need to develop a screening guideline for the Egyptian population.
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Affiliation(s)
- Mohamed Salaheldeen Noor
- Ophthalmology Department, Ain Shams University, Cairo, Egypt,Correspondence: Mohamed Salaheldeen Noor, Ophthalmology Department, Ain Shams University, 22 Abdullah Ibn Eltaher street, Makram Edeid, Nasr city, Cairo, Egypt, Tel +201093769896, Email
| | | | - Sherif N Embabi
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
| | - Mohamed A Zaki
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
| | - Hisham Awad
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
| | - Mariam Al-Feky
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
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Bellach L, Eigenschink M, Hassanein A, Savran D, Salzer U, Müllner EW, Repa A, Klebermass-Schrehof K, Wisgrill L, Giordano V, Berger A. Packed red blood cell transfusion in preterm infants. Lancet Haematol 2022; 9:e615-e626. [PMID: 35901846 DOI: 10.1016/s2352-3026(22)00207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Premature infants commonly receive adult packed red blood cells (pRBCs) during their hospital stay. As adult erythrocytes differ substantially from those of preterm infants, transfusion of adult pRBCs into preterm infants can be considered inappropriate for the physiology of a preterm infant. An absence of standardisation of transfusion protocols makes it difficult to compare and interpret pertinent clinical data, as reflected by unclear associations between pRBC transfusion and complications related to prematurity, such as bronchopulmonary dysplasia, neurodevelopmental impairment, retinopathy of prematurity, or necrotising enterocolitis. The difficulty in interpreting clinical data is further increased by differences in study designs that either overestimate pRBC-associated complications of prematurity or have not yet been designed to directly link pRBC transfusions to their respective complications. Thus, neonatal transfusion practice has become an ongoing difficulty, in which differences in transfusion guidelines hinder the ability to generate comparable clinical data, and heterogeneity in clinical data prevents the implementation of standardised transfusion protocols. To overcome these issues, novel approaches with biochemical-clinical translational designs could enable clinicians to gather causal evidence instead of circumstantial correlation.
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Affiliation(s)
- Luise Bellach
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Eigenschink
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Abtin Hassanein
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Danylo Savran
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Ulrich Salzer
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Ernst W Müllner
- Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Wisgrill
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
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6
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Haghpanah S, Miladi S, Zamani A, Abadi AMKH, Gholami M, Gholami M. A cost-analysis study of using adult red cell packs and Pedi-Packs in newborn intensive care units in Southern Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:15. [PMID: 33676529 PMCID: PMC7937218 DOI: 10.1186/s12962-021-00267-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/23/2021] [Indexed: 11/12/2022] Open
Abstract
Background and objective Saving blood products is an important public health issue especially in developing countries with limited financial resources. We aimed to suggest a new hypothetical model to make a change in the current blood transfusion policy in the newborn intensive care unit (NICU) to reduce wastage of blood supplies as well as the risk of exposure to multiple donors. Methods In this cross-sectional study, all transfused neonates (n = 70) who were admitted to NICU of Nemazee Hospital, a tertiary referral hospital in Southern Iran, were evaluated between March and June 2019. Based on the information of neonates’ transfusion during this study period and determined transfusion indices, a specific pediatric pack was suggested and the related total costs per transfusion, as well as the donor-exposure rate of the hypothetical and the current transfusion method, were compared. Results Considering the mean number of transfusions per neonate: 4 and mean volume of transfused packed red cells: 20 ml per transfusion, the cost-analysis of pediatric and the adult pack was presented. Arithmetically, we proved a higher total cost per transfusion for using adult pack comparing to pediatric pack. Additionally, using a pediatric pack set leads to a 24% reduction in RBCs wastage per transfusion and a 68.13% reduction in donor-exposure rate. Conclusions The assignment of a dedicated pediatric pack for neonates will be able to improve the cost-effectiveness by a substantial reduction in donor-exposure rate and blood wastage. This finding should be taken into consideration to generate economic growth and make improvements in child health status.
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Affiliation(s)
- Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shima Miladi
- Clinical Research Development Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Zamani
- Blood Bank, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Marjan Gholami
- Clinical Research Development Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Gholami
- Clinical Research Development Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kirpalani H, Whyte RK. What Is New about Transfusions for Preterm Infants? An Update. Neonatology 2019; 115:406-410. [PMID: 30974429 DOI: 10.1159/000499048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 11/19/2022]
Abstract
Currently the question of whether to maintain a higher hemoglobin level by transfusing more liberally, as opposed to a more restrictive strategy with lower hemoglobin maintenance levels, has not been answered. We review summarized conclusions of a Cochrane systematic review and meta-analysis of 614 infants in 4 randomized controlled trials (RCT) pooling data. This suggests potential benefits of higher hemoglobin levels, i.e., a possible improved cognition of infants at 18-21 months' corrected age and a reduction of apnea. However, the data on cognition is hypothesis generating as it derives from a post hoc analysis from a single trial in 451 infants. Moreover, the data on apnea need confirmation in larger trials. The effect of adding data of cognitive 2-year outcomes of 1,744 infants from 2 RCT, which will be reported soon, should expand our understanding. This new data will need to be integrated with the older generation of RCTs but also with emerging suggestions from observational data on potential risks of blood transfusions. We discuss some of these warnings from observational studies. Finally, we ask whether we are ready to individualize blood transfusion to physiological measures made in individual infants, and we point to some current difficulties hindering this step.
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Affiliation(s)
- Haresh Kirpalani
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, .,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada,
| | - Robin K Whyte
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Red cell transfusions are amongst the most common therapeutic procedures in seriously ill children, particularly in the inpatient setting. This is despite the fact that there is no evidence base for most clinical settings, with the exception of patients with hemoglobinopathies, particularly thalassemia and sickle cell anemia. Obviously exsanguinating hemorrhage and life threatening anemia are urgent indications for which no other therapeutic approach is currently available. Most transfusions are, however, given prophylactically to prevent the complications of hypoxia or hemodynamic stability, based upon expert opinion and a faith in the oxygen carrying capacity and beneficial hemodynamic properties of transfused red cells. The question confronting current day pediatric practice is to what extent transfused red cells prevent adverse events, other than in thalassemia and sickle cell anemia, as opposed to causing them. Do transfusions of red cells prevent organ failure, stroke, etc. or not? There is epidemiologic evidence in the adult randomized trial literature that liberal red cell transfusion likely causes more such adverse events than it prevents. The relevance of such studies to children, particularly neonates, is uncertain. Randomized trials in critically ill neonates have yielded little to no evidence that liberal red cell transfusion is beneficial, but the data are not definitive. In critically ill older children the data suggest there is no benefit to liberal red cell transfusion, but the indications for red cell transfusion are uncertain. Most practitioners would agree that combining laboratory data such hemoglobin/hematocrit with clinical indications for transfusions (evidence of end organ hypoxia such as tachycardia, shortness of breath, etc.) is the only viable strategy at present, until more definitive randomized trial data are available.
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Podraza W, Michalczuk B, Jezierska K, Domek H, Kordek A, Łoniewska B, Modrzejewska M, Kot J. Correlation of Retinopathy of Prematurity with Bronchopulmonary Dysplasia. Open Med (Wars) 2018; 13:67-73. [PMID: 29607416 PMCID: PMC5874512 DOI: 10.1515/med-2018-0012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 12/15/2017] [Indexed: 11/15/2022] Open
Abstract
Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases that occur only in preterm infants. The etiology of these disorders is multifactorial; however, it is believed that some of the factors in children presenting with BPD affect both the initiation and severity of ROP. The aim of the study was to evaluate the degree of clinical severity of ROP in infants with BPD compared to those without BPD.
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Affiliation(s)
- Wojciech Podraza
- Department of Medical Physics, ul. Ku Sloncu 12, 71-073, Szczecin, Poland
| | - Beata Michalczuk
- Department of Medical Physics, Pomeranian Medical University, Szczecin, Poland
| | - Karolina Jezierska
- Department of Medical Physics, Pomeranian Medical University, Szczecin, Poland
| | - Hanna Domek
- Department of Medical Physics, Pomeranian Medical University, Szczecin, Poland
| | - Agnieszka Kordek
- Department of Neonatal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Beata Łoniewska
- Department of Neonatal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Monika Modrzejewska
- Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Joanna Kot
- Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
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Yum SK, Moon CJ, Youn YA, Lee JH, Kim SY, Sung IK. Expanded criteria for retinopathy of prematurity screening in moderately preterm infants: Single-center pilot study. Pediatr Int 2016; 58:1158-1162. [PMID: 27038039 DOI: 10.1111/ped.12996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/11/2016] [Accepted: 03/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND While developed countries seek to lower the gestational age and birthweight parameters in retinopathy of prematurity (ROP) screening, older, larger infants still develop ROP in other parts of the world. The aim of this study was therefore to define criteria to identify potential ROP developers who are outliers of the common screening range. METHODS A retrospective medical record review was performed in 147 inborn moderately preterm infants admitted to the neonatal intensive care unit during the study period. Univariate and logistic regression analysis was carried out. RESULTS Forty-two infants developed ROP. Gestational age (31.4 ± 1.1 vs 32.4 ± 1.0 weeks, P = 0.000) and birthweight (1607.7 ± 339.4 vs 1846.4 ± 317.2 g, P = 0.000) were lower in those who developed ROP. Respiratory distress syndrome (P = 0.026) and documented sepsis (P = 0.003) were significant comorbidities on univariate analysis. Inotrope need >72 h starting in the first week of life (P = 0.004; OR, 5.181) and more than three transfusions of packed red blood cells (P = 0.028; OR, 3.891) were also significant, both on univariate and multivariate analysis. CONCLUSIONS In moderately preterm infants, status should be evaluated in order to effectively select candidates for ROP screening without missing potential ROP developers.
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Affiliation(s)
- Sook Kyung Yum
- Division of Neonatology, Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Cheong-Jun Moon
- Division of Neonatology, Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Young-Ah Youn
- Division of Neonatology, Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Lee
- Division of Neonatology, Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - So Young Kim
- Division of Neonatology, Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - In Kyung Sung
- Division of Neonatology, Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
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11
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Fang JL, Sorita A, Carey WA, Colby CE, Murad MH, Alahdab F. Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis. Pediatrics 2016; 137:peds.2015-3387. [PMID: 26962240 DOI: 10.1542/peds.2015-3387] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The effectiveness of many interventions aimed at reducing the risk of retinopathy has not been well established. OBJECTIVE To estimate the effectiveness of nutritional interventions, oxygen saturation targeting, blood transfusion management, and infection prevention on the incidence of retinopathy of prematurity (ROP). DATA SOURCES A comprehensive search of several databases was conducted, including Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through March 2014. STUDY SELECTION We included studies that evaluated nutritional interventions, management of supplemental oxygen, blood transfusions, or infection reduction and reported the incidence of ROP and mortality in neonates born at <32 weeks. DATA EXTRACTION We extracted patient characteristics, interventions, and risk of bias indicators. Outcomes of interest were any stage ROP, severe ROP or ROP requiring treatment, and mortality. RESULTS We identified 67 studies enrolling 21 819 infants. Lower oxygen saturation targets reduced the risk of developing any stage ROP (relative risk [RR] 0.86, 95% confidence interval [CI], 0.77-0.97) and severe ROP or ROP requiring intervention (RR 0.58, 95% CI, 0.45-0.74) but increased mortality (RR 1.15, 95% CI, 1.04-1.29). Aggressive parenteral nutrition reduced the risk of any stage ROP but not severe ROP. Supplementation of vitamin A, E, or inositol and breast milk feeding were beneficial but only in observational studies. Use of transfusion guidelines, erythropoietin, and antifungal agents were not beneficial. LIMITATIONS Results of observational studies were not replicated in randomized trials. Interventions were heterogeneous across studies. CONCLUSIONS At the present time, there are no safe interventions supported with high quality evidence to prevent severe ROP.
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Affiliation(s)
| | | | | | | | | | - Fares Alahdab
- Preventive Medicine, Mayo Clinic, Rochester, Minnesota
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12
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Outcomes of a Quality Improvement Initiative to Prevent Unnecessary Packed Red Blood Cell Transfusions Among Extremely Low Birth-Weight Neonates. Adv Neonatal Care 2016; 16:E3-9. [PMID: 26734813 DOI: 10.1097/anc.0000000000000249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extremely low birth-weight (ELBW) infants frequently receive packed red blood cell (PRBC) transfusions. Recent studies have shown that more restrictive PRBC transfusion guidelines limit donor exposure and reduce transfusion-related costs without any increase in adverse clinical outcomes. PURPOSE We developed and implemented an evidence-based PRBC transfusion guideline for ELBW infants treated in our unit and then measured provider adherence to this guideline. METHODS/SEARCH STRATEGY We performed a retrospective review of all PRBC transfusions given to ELBW infants in 2012 (preguideline) and the first half of 2014 (postguideline). We identified the indication for each transfusion by reviewing physiological/laboratory data and the daily clinical note. We then determine whether each transfusion met criteria according to our new evidence-based guideline. FINDINGS/RESULTS When extrapolating the newly developed protocol to 2012 data, less than 15% of transfusions among ELBW infants would have met the current evidence-based standard. Conversely, during the first 6 months of 2014, 61% of transfusions were administered in adherence to the guideline (P < 001). Using current cost estimates, this represents a projected cost savings of $31,000 in that 6-month period. IMPLICATIONS FOR PRACTICE A multidisciplinary approach to improving PRBC transfusion practices results in potentially safer, more cost-effective care for ELBW infants. IMPLICATIONS FOR RESEARCH Given the frequency, potential harms, and costs associated with PRBC transfusions in ELBW infants, it seems both feasible and important to pursue prospective clinical trials comparing permissive and restrictive approaches to transfusion in this vulnerable population.
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dos Santos AMN, Guinsburg R, de Almeida MFB, Procianoy RS, Marba STM, Ferri WAG, Rugolo LMDS, Lopes JMA, Moreira MEL, Luz JH, González MRC, Meneses JDA, da Silva RVC, Abdallah VOS, Duarte JLMB, Marques PF, Rego MAS, Alves Filho N, Krebs VLJ. Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units. BMC Pediatr 2015; 15:113. [PMID: 26341125 PMCID: PMC4560891 DOI: 10.1186/s12887-015-0432-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/21/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. METHODS A prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. RESULTS A total of 2208 (51.6%) infants received RBC transfusions (variation per neonatal unit: 34.1% to 66.4%). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. CONCLUSIONS The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.
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Affiliation(s)
| | - Ruth Guinsburg
- Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | | | - José Maria Andrade Lopes
- Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira - Fundação Oswaldo Cruz, Avenida Rui Barbosa, 716, Rio de Janeiro, RJ, CEP 22420040, Brazil.
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira - Fundação Oswaldo Cruz, Avenida Rui Barbosa, 716, Rio de Janeiro, RJ, CEP 22420040, Brazil.
| | - Jorge Hecker Luz
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Lin T, Maita D, Thundivalappil SR, Riley FE, Hambsch J, Van Marter LJ, Christou HA, Berra L, Fagan S, Christiani DC, Warren HS. Hemopexin in severe inflammation and infection: mouse models and human diseases. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:166. [PMID: 25888135 PMCID: PMC4424824 DOI: 10.1186/s13054-015-0885-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/16/2015] [Indexed: 01/14/2023]
Abstract
Introduction Cell-free plasma hemoglobin is associated with poor outcome in patients with sepsis. Extracellular hemoglobin and secondarily released heme amplify inflammation in the presence of microbial TLR ligands and/or endogenous mediators. Hemopexin, a plasma protein that binds heme with extraordinary affinity, blocks these effects and has been proposed as a possible treatment approach to decrease inflammation in critically ill patients. Methods We studied mouse models of endotoxemia, burn wound infections and peritonitis in order to assess if a repletion strategy for hemopexin might be reasonable. We also measured hemopexin in small numbers of three patient populations that might be logical groups for hemopexin therapy: patients with sepsis and ARDS, patients with severe burns, and premature infants. Results Despite severe disease, mean plasma hemopexin levels were increased above baseline in each murine model. However, plasma hemopexin levels were decreased or markedly decreased in many patients in each of the three patient populations. Conclusions Potentially different behavior of hemopexin in mice and humans may be important to consider when utilizing murine models to represent acute human inflammatory diseases in which heme plays a role. The findings raise the possibility that decreased hemopexin could result in insufficiently neutralized or cleared heme in some patients with ARDS, burns, or in premature infants who might be candidates to benefit from hemopexin administration. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0885-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tian Lin
- Department of Pediatrics, Infectious Disease Unit, Massachusetts General Hospital, and Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
| | - Dayana Maita
- Department of Pediatrics, Infectious Disease Unit, Massachusetts General Hospital, 149 13th Street, Charlestown, MA, 02129, USA.
| | - Sujatha R Thundivalappil
- Department of Pediatrics, Infectious Disease Unit, Massachusetts General Hospital, 149 13th Street, Charlestown, MA, 02129, USA.
| | - Frank E Riley
- Department of Pediatrics, Infectious Disease Unit, Massachusetts General Hospital, 149 13th Street, Charlestown, MA, 02129, USA.
| | - Jasmin Hambsch
- Department of Pediatrics, Infectious Disease Unit, Massachusetts General Hospital, 149 13th Street, Charlestown, MA, 02129, USA.
| | - Linda J Van Marter
- Department of Pediatric Newborn Medicine at Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Helen A Christou
- Department of Pediatric Newborn Medicine at Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Lorenzo Berra
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Shawn Fagan
- Department of Surgery, MGH Burn Service, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - David C Christiani
- Department of Medicine, Pulmonary and Critical Care Medicine, Massachusetts General Hospital, and Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
| | - H Shaw Warren
- Department of Pediatrics and Medicine, Infectious Disease Unit, Massachusetts General Hospital, and Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
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