A novel approach to standardised recording of bleeding in a high risk neonatal population

Venkatesh, Vidheya; Curley, Anna; Khan, Rizwan; Clarke, Paul; Watts, Timothy; Josephson, Cassandra D.; Muthukumar, P; New, Helen; Seeney, Frances; Morris, Scott; Stanworth, Simon

doi:10.1136/archdischild-2012-302443

Cited by 47 publications

(39 citation statements)

References 5 publications

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“…We ascertained bleeding events during the first 96 hours after birth based on a diagnosis of or notation of abnormal bleeding in physician, nursing or respiratory therapist documentation. We also adapted the Neonatal Bleeding Assessment Tool (NeoBAT), a validated bleeding assessment tool, to retrospectively assess the severity of abnormal bleeding events 14. We used the modified NeoBAT to ascribe all patients with bleeding events a modified WHO bleeding assessment scale score (scale of 1–4, with 4 being the most severe).…”

Section: Methodsmentioning

confidence: 99%

“…We also adapted the Neonatal Bleeding Assessment Tool (NeoBAT), a validated bleeding assessment tool, to retrospectively assess the severity of abnormal bleeding events. 14 We used the modified NeoBAT to ascribe all patients with bleeding events a modified WHO bleeding assessment scale score (scale of 1-4, with 4 being the most severe). Patients without bleeding were assigned a score of 0.…”

Section: Patient Populationmentioning

confidence: 99%

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Observational study of haemostatic dysfunction and bleeding in neonates with hypoxic–ischaemic encephalopathy

et al. 2017

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ObjectiveEvaluate the relationship between initial haemostatic parameters and the frequency and severity of bleeding in neonates with hypoxic–ischaemic encephalopathy (HIE).DesignRetrospective observational cohort study.Setting2 academically affiliated level III neonatal intensive care units in Atlanta, Georgia.Participants98 neonates with moderate-to-severe HIE who underwent haemostatic testing within 12 hours of birth and were born from 1 January 2008 to 31 December 2013.Primary and secondary outcome measuresInitial haemostatic dysfunction was defined as one or more of the following: prothrombin time (PT) ≥18 s, platelet count <100×103/μL or fibrinogen <150 mg/dL. Bleeding assessed using the Neonatal Bleeding Assessment Tool and graded according to the WHO bleeding scale. The robust Poisson regression was used to evaluate the independent association between components of initial haemostatic dysfunction and bleeding.ResultsAmong the 98 neonates evaluated, the prevalence of initial haemostatic dysfunction was 69% (95% CI 59% to 78%). 27 neonates (28%; 95% CI 19% to 38%) had abnormal bleeding events and 56 (57%) received at least 1 blood product transfusion. 3 neonates died from bleeding complications. The most common products transfused were fresh-frozen plasma (71%), followed by packed red blood cells (24%) and platelets (21%). In multivariable analysis, fibrinogen <150 mg/dL (adjusted relative risk 2.41, 95% CI 1.09 to 5.36) and platelet count <100×103/μL (adjusted relative risk 2.59, 95% CI 1.30 to 5.16), but not initial PT, were associated with an increased risk of bleeding. The most severe bleeding occurred in neonates with a fibrinogen <150 mg/dL.ConclusionsAmong neonates with moderate-to-severe HIE, haemostatic dysfunction is prevalent and associated with an increased risk of bleeding and high transfusion burden. Further studies are needed to determine the appropriate transfusion approaches in this population to prevent bleeding.

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Section: Methodsmentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

Observational study of haemostatic dysfunction and bleeding in neonates with hypoxic–ischaemic encephalopathy

et al. 2017

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“…For the purposes of this study, bleeding will be recorded on a specifically designed, validated bleeding assessment tool [14] and graded according to the following definitions: minor, moderate, major and severe (table 1). The platelet transfusion dose will be 15 ml/kg and will adhere to current UK specifications for apheresis platelets of a platelet cell content >240 × 10 9 per adult unit.…”

Section: Summary Of Studymentioning

confidence: 99%

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

et al. 2014

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Introduction: Neonatal thrombocytopenia is a common and important clinical problem in preterm neonates. A trial assessing clinically relevant outcomes in relation to the different platelet count thresholds used to trigger transfusion has never been undertaken in preterm neonates with severe thrombocytopenia. Objectives: Platelets for Neonatal Transfusion - Study 2 (PlaNeT-2) aims to assess whether a higher prophylactic platelet transfusion threshold is superior to the lower thresholds in current standard practice in reducing the proportion of patients who have a major bleed or die up to study day 28. Methods: PlaNeT-2 is a two-stage, randomised, parallel-group, superiority trial. PlaNet-2 compares clinical outcomes in preterm neonates (<34 weeks' gestation at birth) randomised to receive prophylactic platelet transfusions to maintain platelet counts at or above either 25 × 10⁹/l or 50 × 10⁹/l. The primary outcome measure is the proportion of patients who either die or experience a major bleed up to and including study day 28. A total of 660 infants will be randomised. Results and Conclusions: This trial will help define optimal platelet transfusion support for severely thrombocytopenic preterm neonates by evaluating the risks and benefits of two different prophylactic neonatal platelet transfusion thresholds.

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“…Also, the usefulness of obtaining coagulation tests from nonbleeding preterm neonates is unclear, because the lack of appropriate reference intervals for preterm neonates obfuscates accurate interpretation of the reported values . Moreover, when coagulation tests appear to be abnormal, it is not certain whether FFP administration actually reduces the odds of a subsequent hemorrhage …”

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confidence: 99%

Reference intervals for common coagulation tests of preterm infants (CME)

et al. 2013

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A novel approach to standardised recording of bleeding in a high risk neonatal population

Cited by 47 publications

References 5 publications

Observational study of haemostatic dysfunction and bleeding in neonates with hypoxic–ischaemic encephalopathy

Observational study of haemostatic dysfunction and bleeding in neonates with hypoxic–ischaemic encephalopathy

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

Reference intervals for common coagulation tests of preterm infants (CME)

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