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Cortesi V, Cavallaro G, Raffaeli G, Ghirardello S, Mosca F, Klei TR, Fustolo-Gunnink S, Stanworth S, New HV, Deschmann E, Lopriore E. Why might cord blood be a better source of platelets for transfusion to neonates? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:292-302. [PMID: 38557319 PMCID: PMC11251836 DOI: 10.2450/bloodtransfus.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 04/04/2024]
Abstract
Thrombocytopenia (defined as a platelet count <150×109/L) is a common condition in preterm neonates and may occur in 18-35% of all infants admitted to the Neonatal Intensive Care Unit (NICU). Neonatal platelet functionality in terms of reactivity is often described as reduced compared to adults, even in healthy, term neonates. However, this platelet "hyporeactivity" does not correspond to a global functional impairment of the normal delicately balanced neonatal hemostatic system. The extent to which neonatal thrombocytopenia and platelet hyporeactivity contribute to the bleeding risk in preterm neonates remains unknown. Prophylactic platelet transfusions are often administered to them to reduce the risk of bleeding. However, recent literature indicates that adopting a higher platelet transfusion threshold than a lower one results in significantly higher death rates or major bleeding and can be harmful. Although the mechanism by which this occurs is not entirely clear, a mismatch between adult transfused platelets and the neonatal hemostatic system, as well as volume overload, are speculated to be potentially involved. Therefore, future research should consider novel transfusion products that may be more suitable for premature neonates. Blood products derived from umbilical cord blood (UCB) are promising, as they might perfectly match neonatal blood features. Here, we discuss the current knowledge about UCB-derived products, focusing on UCB-derived platelet concentrates and their potential for future clinical application. We will discuss how they may overcome the potential risks of transfusing adult-derived platelets to premature infants while maintaining efficacy.
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Affiliation(s)
- Valeria Cortesi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Thomas R.L. Klei
- Department of Product and Process Development, Sanquin Blood Supply, Amsterdam, the Netherlands
| | - Suzanne Fustolo-Gunnink
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pediatric Hematology, Emma Children’s Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Simon Stanworth
- Department of Hematology, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Helen V. New
- Clinical Directorate, NHS Blood and Transplant, London, United Kingdom
| | - Emöke Deschmann
- Department of Neonatology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
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Fassino B, Ferrario S, Sorrentino G, Adamini I, Pesenti N, Fumagalli M, Mosca F, Plevani L. Hospital-acquired skin lesions in the neonatal intensive care unit: A retrospective analysis of temporal trends and quality improvement strategies. J Pediatr Nurs 2023; 70:40-46. [PMID: 36796303 DOI: 10.1016/j.pedn.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Skin lesions in neonatal population are an emerging problem deserving attention from health care professionals. The purpose of this study is to retrospectively assess the incidence of hospital-acquired skin lesions during a 6-year period and to describe the characteristics of infants who developed them. DESIGN AND METHODS This was a retrospective observational study conducted in a university-tertiary care center between 2015 and 2020. A descriptive analysis of the observed skin lesions is presented according to 2 time periods: 1) the implementation phase of a quality improvement program (2015-2019) and 2) the postimplementation phase (2020). RESULTS Our findings showed an apparent increase in the incidence of all reported skin lesions throughout the study period. Pressure injuries were the most frequently reported skin lesions showing an increasing incidence over time which, however, was paralleled by a reduction in their severity. Among pressure injuries, device-related injuries were the most commonly observed (56.6% and 62.5% in the two periods, respectively) with nasal continuous positive airway pressure-related injuries accounting for 71.7% and 56.0% of lesions, respectively, and mainly affecting the nose root. The occipital area was the most frequently involved site in cases of conventional pressure injuries. CONCLUSION Infants admitted to Neonatal Intensive Care Units may be at high risk of developing skin lesions. The adoption of appropriate preventative as well as treatment interventions could be effective in reducing the severity of pressure injuries. PRACTICE IMPLICATIONS The implementation of quality improvement strategies may contribute to prevent skin injuries or lead to their early detection.
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Affiliation(s)
- Barbara Fassino
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Silvia Ferrario
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Gabriele Sorrentino
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Ileana Adamini
- Healthcare Professions Department Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
| | - Nicola Pesenti
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, 20126 Milan, Italy.
| | - Monica Fumagalli
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, via Festa del Perdono 7, 20122 Milan, Italy.
| | - Fabio Mosca
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, via Festa del Perdono 7, 20122 Milan, Italy.
| | - Laura Plevani
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 28, 20122 Milan, Italy.
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Falsaperla R, Biondi GM, Motta M, Gallerano P, Tancredi G, Pavone P, Ruggieri M. Impressive Nasal Septum Regeneration after Cord Blood Platelet Gel (CBPG) in Extreme Premature Neonate with Non-Invasive Ventilation: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1767. [PMID: 36421216 PMCID: PMC9689260 DOI: 10.3390/children9111767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 09/15/2023]
Abstract
BACKGROUND We evaluated the efficacy of Cord Blood Platelet Gel (CBPG) in the regenerative reconstruction of the nasal septal tissue of a preterm infant undergoing non-invasive ventilation. METHODS A CBPC treatment was used to enhance the regeneration of the nasal septum of a premature patient in an experimental way, evaluating the efficacy described in the literature (selective bibliographic search in PubMed) of the use of blood products for non-transfusion purposes. RESULTS A partial but satisfactory regeneration of the patient's nasal septum was observed. Using the free NIH Image J online software, we were able to calculate the regenerated surface (about 83% of the destroyed cartilage). CONCLUSIONS The use of platelet gel has been a promising alternative to surgical treatment in patients with severe damage to the nasal septum.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit, AUO Policlinico “Rodolico-San Marco”, University of Catania, 95121 Catania, Italy
| | - Giulia Marialidia Biondi
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Milena Motta
- Neonatal Intensive Care Unit, AUO Policlinico “Rodolico-San Marco”, University of Catania, 95121 Catania, Italy
| | - Pasquale Gallerano
- Transfusional Medicine, Complex Operative Unit, PO “Giovanni Paolo II”, 92019 Sciacca, Italy
| | - Giusi Tancredi
- Transfusional Medicine, Complex Operative Unit, PO “Giovanni Paolo II”, 92019 Sciacca, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsichiatry, Department of Child and Experimental Medicine, University of Catania, AOU “Policlinico PO” G. Rodolico, 95123 Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsichiatry, University of Catania, AOU “Policlinico PO” G. Rodolico, 95123 Catania, Italy
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Foffa I, Janowska A, Fabbri M, Losi P, Ciabatti E, Gabbriellini S, Faita F, Rosa LD, Dini V, Mazzoni A, Romanelli M, Soldani G. Carboxymethyl Cellulose-Based Hydrogel Film Combined with Umbilical Cord Blood Platelet gel as an Innovative Tool for Chronic Wound Management: A Pilot Clinical Study. INT J LOW EXTR WOUND 2022:15347346221138189. [PMID: 36380524 DOI: 10.1177/15347346221138189] [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: 02/17/2024]
Abstract
Treatment of chronic leg ulcers remains a major challenge and it is a substantial financial burden on individuals, families, caregivers, and health care system. There is increasing evidence on using of autologous Platelet-rich-plasma in wound repair but limited clinical data are available on the efficacy and safety of the use of umbilical cord blood platelet gel (CBPG). In our pilot study, for the first time, we aimed to evaluated the safety and efficacy of the use of umbilical CBPG combined with a hydrogel dressing in 10 patients with chronic venous ulcers (VU). The protocol consisted of application of umbilical cord blood platelet-rich plasma (PRP) combined with a Carboxymethyl cellulose (CMC)-based hydrogel dressing once a week for 4 weeks. The 80% of patients after 4 weeks of treatment had a significantly decrease in wound size. Moreover, we obtained an improvement in terms of mean Wound Bed Score (WBS), numeric rating scale (NRS) value and the EQ-5D index score. This pilot study showed that the topically therapeutic administration of umbilical CBPG associated with a CMC-based hydrogel dressing has the potential to accelerate the healing of chronic lesions without adverse reaction. However, additional studies with larger sample size and longer follow-up periods are required to confirm our findings.
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Affiliation(s)
- Ilenia Foffa
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
| | - Agata Janowska
- Unit of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Marco Fabbri
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | - Paola Losi
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
| | - Elena Ciabatti
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | - Sabrina Gabbriellini
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
| | - Laura De Rosa
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Valentina Dini
- Unit of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Alessandro Mazzoni
- Transfusion Medicine and Transplant Biology, 9257Pisa University Hospital, Pisa, Italy
| | | | - Giorgio Soldani
- Institute of Clinical Physiology, National Research Council, Massa, Pisa, Italy
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