Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Baer, Vickie L.; Lambert, D K; Schmutz, N; Henry, Erick; Stoddard, Ronald A.; Miner, C A; Wiedmeier, Susan E.; Burnett, Jill; Eggert, Larry D.; Christensen, Robert D.

doi:10.1038/jp.2008.23

Cited by 51 publications

(54 citation statements)

References 23 publications

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“…None of these erythrocyte or platelet transfusions were for treatment of hemorrhagic complications; rather, all were prophylactic, meaning that the hemoglobin, hematocrit or platelet count fell below the transfusion 'trigger' level. 12 The transfusions were finished 18 ± 12 h before the Anderson tube was placed. One patient had two episodes of supraventricular tachycardia as antecedents of the NEC, each being successfully treated with adenosine but not with ice to the face.…”

Section: Resultsmentioning

confidence: 99%

Antecedents of Bell stage III necrotizing enterocolitis

et al. 2009

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Objective: New biopharmaceuticals hold promise for preventing or treating necrotizing enterocolitis. However, it is unclear whether any such biopharmaceutical that requires enteral administration could be administered using an 'early-treatment' paradigm. This study was undertaken to assess this issue based on data from every case of Bell stage III NEC cared for during the past 7 years at Intermountain Healthcare.Study Design: Patients with Bell stage III NEC were identified from electronic medical record repositories and the diagnosis was validated using operative reports. Electronic and paper records of each patient were then used to identify potential clinical and laboratory antecedents occurring within the 48 h period preceding the diagnosis of NEC.Result: One hundred eighteen patients had Stage III NEC. The earliest recognized antecedents were nonspecific for NEC (apnea/bradycardia, skin mottling and irritability). These were recorded at 2.8±2.1, 4.5±3.1 and 5.4±3.7 (mean±s.d.) hours, respectively, before NEC was diagnosed. The most commonly identified gastrointestinal antecedents were blood in the stools, increased abdominal girth and elevated pre-feeding gastric residuals or emesis. These were identified 2.0 ± 1.9, 2.8 ± 3.1 and 4.9 ± 4.0 h before NEC was recognized. Thirty-eight percent had a blood transfusion (18±12 h) preceding the NEC. Tachycardia, tachypnea, hypotension and diarrhea were rarely identified as antecedents and no consistent laboratory antecedents were discovered. Conclusion:We judge that an 'early treatment of NEC' paradigm testing any pharmacological agent that must be administered enterally is not feasible. The first recognized antecedents of Bell stage III NEC are nonspecific for gastrointestinal pathology and insufficient time exists for dosing between the first gastrointestinal signs and placement of the gastric decompression tube.

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Section: Resultsmentioning

confidence: 99%

Antecedents of Bell stage III necrotizing enterocolitis

et al. 2009

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“…Petäjä et al [32] reported that only about 35% of platelet transfusions given were compliant with previously agreed upon guidelines. In the Intermountain Healthcare System, we audited all NICU transfusions given during the year 2006 and determined that about 65% of platelet transfusions were compliant with our guidelines, thus 35% were not [33] . In January 2009, we initiated a system-wide program aimed at increasing compliance with transfusion guidelines.…”

Section: Compliance With Platelet Transfusion Guidelinesmentioning

confidence: 99%

Platelet Transfusion in the Neonatal Intensive Care Unit: Benefits, Risks, Alternatives

Christensen¹

2011

Neonatology

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Platelet transfusions were introduced into clinical medicine about 60 years ago when they were shown to reduce the mortality rate of patients with leukemia who were bleeding secondary to hyporegenerative thrombocytopenia. In modern neonatology units, platelet transfusions are integral and indeed lifesaving for some neonates. However, the great majority of platelet transfusions currently administered in neonatal intensive care units (NICUs) are not given in the original paradigm to treat thrombocytopenic hemorrhage, but instead are administered prophylactically with the hope that they will reduce the risk of spontaneous bleeding. Weighing the risks and benefits of platelet transfusion, although imprecise, should be attempted each time a platelet transfusion is ordered. Adopting guidelines specific for platelet transfusion will improve consistency of care and will also generally reduce transfusion usage, thereby reducing costs and conserving valuable blood bank resources. Initiating specific programs to improve compliance with transfusion guidelines can further improve NICU transfusion practice.

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“…In brief, the guidelines recommend transfusion if the hematocrit falls below 35% for a patient on mechanical ventilation, below 27% for a patient on supplemental oxygen or with signs of anemia but not on mechanical ventilation and below 20% in any NICU patient. Compliance with these guidelines for the year 2006 was 70%, 4 and compliance for the year 2009 was 90%. 5 When NEC was identified, radiographic images, radiographic reports and physician's notes pertaining to NEC were reviewed.…”

Section: Methodsmentioning

confidence: 99%

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

et al. 2011

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Objective: We hypothesized that neonates with bloody stools and concomitant eosinophilia are likely to have atopic enteropathy rather than necrotizing enterocolitis (NEC).Study Design: This was a retrospective cross-sectional study using electronic medical records and paper charts. Records of neonates admitted to any Intermountain Healthcare NICU between 1 January 2005 and 30 June 2010 were eligible if 'bloody stools' were listed in any archive. Qualifying records were divided into two groups depending on whether or not within 72 h of passing bloody stool eosinophil counts were above the 95th percentile reference range limit for age.Result: Bloody stools were identified in 275 predominantly Caucasian neonates. Fifty-four of these had eosinophilia and 221 had normal eosinophil counts. Those with eosinophilia were born at a slightly younger gestational age (31.3±4.6 vs 32.6±4.0 weeks, mean±s.d., P ¼ 0.032). Contrary to our hypothesis, those with eosinophilia did not have a lower rate of pneumatosis or bowel resection, or death ascribed to NEC. Eosinophilia was more common among those who had a red blood cell (RBC) transfusion within 48 h before passing bloody stools (P<0.001). Those with a recent RBC transfusion were the only neonates to have NEC surgery or to die from NEC. Preceding the bloody stools, those with no antecedent transfusion had been fed a larger volume (P ¼ 0.014), and had trends toward receiving calorically enriched feedings (P ¼ 0.055) and recent addition of human milk fortifier (P ¼ 0.060). Eosinophil counts following RBC transfusion tended to increase for 3-6 days, but when bloody stools were not preceded by transfusion the eosinophil counts were more static over that period. Conclusion:In this predominantly Caucasian group of neonates with bloody stools, the presence of eosinophilia did not identify a benign condition distinct from NEC. A total of 44% of these neonates had transfusion-associated NEC. Eosinophils could have a previously unrecognized role in the pathogenesis of this NEC subtype. Keywords: necrotizing enterocolitis; bloody stools; eosinophilia; RBC transfusion; transfusion-associated NEC; atopic enteropathy Introduction Eosinophilia is diagnosed when the concentration of eosinophils in the blood exceeds the upper reference range limit. 1 Until recently, this upper limit was not well defined for neonates, allowing imprecision in defining eosinophilia and in identifying associations between it and various clinical conditions. Using laboratory values from over 63 000 neonates we recently reported the 5th and 95th percentile values for blood eosinophil concentrations at various gestational and postnatal ages. 2 The 95th percentile upper limit ranges from 1180 eosinophils ml À1 in the first week to about 1560 ml À1 after 3 weeks. 2 Given this more precise definition of neonatal eosinophilia, we commenced the present study of the association between bloody stools and eosinophilia.When bloody stools are observed in a neonate, the possibility of necrotizing enterocolitis (NEC) enters the ...

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Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Cited by 51 publications

References 23 publications

Antecedents of Bell stage III necrotizing enterocolitis

Antecedents of Bell stage III necrotizing enterocolitis

Platelet Transfusion in the Neonatal Intensive Care Unit: Benefits, Risks, Alternatives

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

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