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Journal of Pediatrics, The

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Variation in Neonatal Transfusion Practice - 22/07/21

Doi : 10.1016/j.jpeds.2021.04.002 
Ravi M. Patel, MD, MSc 1, ⁎ , Jeanne E. Hendrickson, MD 2, Marianne E. Nellis, MD, MS 3, Rebecca Birch, MPH 4, Ruchika Goel, MD, MPH 5, 6, Oliver Karam, MD, PhD 7, Matthew S. Karafin, MD, MS 8, Sheila J. Hanson, MD, MS 9, Bruce S. Sachais, MD, PhD 10, Ronald George Hauser, MD 2, Naomi L.C. Luban, MD 11, Jerome Gottschall, MD 8, Cassandra D. Josephson, MD 12, Martha Sola-Visner, MD 13
for the

National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P)

A.E. Mast, E.A. Hod, B.S. Custer, E.P. Vichinsky, B.R. Spencer, S.M. Mathew, D.R. Harris, M.P. Busch, P.J. Norris, P.M. Ness, S.H. Kleinman, R. Tamburro, S.A. Glynn, K. Malkin

1 Department of Pediatrics, Division of Neonatology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA 
2 Departments of Laboratory Medicine and Pediatrics, Yale University, New Haven, CT 
3 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY 
4 Public Health & Epidemiology Practice, Westat, Rockville, MD 
5 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 
6 Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, IL 
7 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 
8 Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC 
9 Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin and Children’s Milwaukee, Milwaukee, WI 
10 New York Blood Center, New York, NY 
11 Children's Research Institute, Children's National Health System, Washington, DC 
12 Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA 
13 Division of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA 

∗Reprint requests: Ravi M. Patel, MD, MSc, Emory University School of Medicine and Children’s Healthcare of Atlanta, 2015 Uppergate Dr NE, Room 312, Atlanta, GA 30322.Emory University School of Medicine and Children’s Healthcare of Atlanta2015 Uppergate Dr NERoom 312AtlantaGA30322

Abstract

Objective

To estimate the incidence of blood product transfusion, including red blood cells, platelets, and plasma, and characterize pretransfusion hematologic values for infants during their initial hospitalization after birth.

Study design

Retrospective cohort study using data from 7 geographically diverse US academic and community hospitals that participated in the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) from 2013 to 2016. Pretransfusion hematologic values were evaluated closest to each transfusion and no more than 24 hours beforehand.

Results

Data from 60 243 infants were evaluated. The incidence of any transfusion differed by gestational age (P < .0001), with 80% (95% CI 76%-84%) transfused at <27 weeks of gestation (n = 329) and 0.5% (95% CI 0.5%-0.6%) transfused at ≥37 weeks of gestation (n = 53 919). The median pretransfusion hemoglobin was 11.2 g/dL (10th-90th percentile 8.8-14.1) for the entire cohort, ranging from 10.5 g/dL (8.8-12.3) for infants born extremely preterm at <27 weeks of gestation to 13.0 g/dL (10.5-15.5) for infants born at term. The median pretransfusion platelet count (×109/L) was 71 (10th-90th percentile 26-135) for the entire cohort, and was >45 for all gestational age groups examined. The median pretransfusion international normalized ratio for the entire cohort was 1.7 (10th-90th percentile 1.2-2.8).

Conclusions

There is wide variability in pretransfusion hemoglobin, platelet count, and international normalized ratio values for neonatal transfusions. Our findings suggest that a large proportion of neonatal transfusions in the US are administered at thresholds greater than supported by the best-available evidence and highlight an opportunity for improved patient blood management.

Le texte complet de cet article est disponible en PDF.

Key words : red blood cell, platelet, plasma, blood, infant, preterm

Abbreviations : ECMO, Hb, ICD, ICU, INR, NICU, RBC, REDS-III


Plan


 Supported by research contracts from the National Heart, Lung, and Blood Institute (NHLBI Contracts HHSN 75N92019D00032, HHSN 75N92019D00034, 75N92019D00035, HHSN 75N92019D00036, and HHSN 75N92019D00037). Additional funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). R.P. received funding from NHLBI (K23 HL128942). The funding source designated an investigator-led steering committee, which independently oversaw the design and conduct of the study and interpretation of the data, preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication. The authors declare no conflicts of interest.
 Portions of this study were presented at the American Association of Blood Banks (AABB) Annual Meeting on October 4, 2020 (virtual); and at the Pediatric Academic Societies annual meeting, May 4, 2021 (virtual).


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Vol 235

P. 92 - août 2021 Retour au numéro
Article précédent Article précédent
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