Transfusion strategies for neonates: current perspectives

Background

Blood transfusion intervention has been proven to be a crucial therapeutic aid for preterm infants with serious morbidities such as sepsis, intraventricular hemorrhage, and cardiopulmonary insufficiencies. However, blood transfusion practices have also been shown to cause significant adverse outcomes, which may negate the therapeutic effect of the intervention. To address the varying policies regarding the administration of blood products, healthcare professionals have adopted a consensus-based approach. The absence of a standard protocol has resulted in conflicting outcomes in previous clinical studies.

Objective

This study aimed to evaluate the effectiveness of blood transfusion practices in preterm infants by analyzing past clinical research and identifying the current trends that have emerged as a result of recent trials.

Results

Recent trials have demonstrated comparable trends in mortality rates and other primary outcomes, including retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia, and brain injury, following transfusion of blood products in both groups. Nevertheless, employing restrictive thresholds rather than adopting a liberal approach can reduce these outcomes.

Conclusion

The current literature does not provide clear support for either technique as opposing and contradictory results are evident. However, there is a slight inclination toward the restrictive transfusion threshold due to recent trials, which warrants further in-depth investigation into this issue.

Awareness of palliative medicine among Pakistani doctors: a survey

OBJECTIVE

To establish the awareness of palliative medicine in Pakistani doctors through a questionnaire.

METHODS

A questionnaire was developed after consultation with the professionals working in palliative medicine. It was distributed, by hand, to a convenience sample of doctors who worked at various teaching hospitals in Pakistan. The distribution and collection of questionnaires was carried out within six months.

RESULTS

The results suggested that 74% doctors felt that cancer was the commonest reason for the palliative care teams to be involved. Forty five percent mentioned tht pain control was their prime job; 54% said that they had some experience of palliative medicine; 64% wanted to be involved in palliative medicine; 60% thought that they broke bad news properly to the patients; 59% were satisfied with their own performance while dealing with an incurable patient (57% said that they had heard about a hospice). There was a wide range of drugs for the cancer pain.

CONCLUSION

Amongst Pakistani doctors, there is a lack of training in palliative medicine. A significant number of doctors are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care.

Randomised, prospective, controlled trial comparing tropisetron with metoclopramide and placebo in controlling postoperative nausea and vomiting

OBJECTIVE

To compare the results of Tropisetron, Metoclopramide and placebo on postoperative nausea and vomiting in patients undergoing minilaparotomy cholecystectomy.

SETTING

Patients operated for minilaparotomy cholecystectomy in two private hospitals in Karachi.

SUBJECTS

Fifty consecutive patients of all ages and both sex who had simple cholelithiasis and underwent minilaparotomy cholecystectomy by a single surgeon.

MAIN OUTCOME MEASURES

Postoperative nausea and vomiting (PONV) at 2 hours and within 24 hours and requirement of rescue antiemetic.

RESULTS

Tropisetron was better than Metoclopramide and placebo in controlling postoperative nausea and vomiting.

CONCLUSION

Tropisetron when given at induction at a dose of 2 mg. intravenously prevents PONV better than Metoclopramide and placebo in 2 hours and 24 hours. It also reduces the need for rescue antiemetic significantly.