Do platelet transfusions in the NICU adversely affect survival? Analysis of 1600 thrombocytopenic neonates in a multihospital healthcare system

Baer, Vickie L.; Lambert, D K; Henry, Erick; Snow, Greg; Sola‐Visner, Martha; Christensen, Richard C.

doi:10.1038/sj.jp.7211833

Cited by 99 publications

(87 citation statements)

References 21 publications

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“…Thus, whether the longer bleeding times among the earliest gestation neonates contribute in any way to hemorrhages remains speculative. 11,12 Many recent reports, [13][14][15][16][17] including studies by our group, [14][15][16][17] indicate that neonatologists sometimes order platelet transfusions for nonbleeding neonates whose platelet counts are in the 100 000 to 150 000 per microliter range. This range is sometimes called 'mild' thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several publications have begun to define risks of platelet transfusions in neonates. [13][14][15][16][17][18] Thus, it is possible that nonbleeding neonates with mild thrombocytopenia who receive platelet transfusions are subjected to transfusion risks but derive no transfusion benefits. In the present study, we found no prolongation of the bleeding time among neonates with mild thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

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Template bleeding times of 240 neonates born at 24 to 41 weeks gestation

et al. 2008

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Objective: The template bleeding time is a test used to assess the hemostatic effectiveness of platelet/endothelial interactions. A modified template bleeding time, described over 15 years ago by Andrew et al., has been used to test this aspect of hemostasis in term and preterm infants, but questions remain regarding the effect of gestational age and postnatal age on results. The effect of the platelet count (platelets per microliter blood) and the circulating platelet mass (nl platelets per microliter blood) on the bleeding time of neonatal intensive care unit (NICU) patients also require better definition.Study Design: We measured template bleeding times on 240 neonates at Ospedale A Perrino, in Brindisi, Italy; studying groups of n ¼ 60 at the following gestational ages; <28 weeks, 29 to 32 weeks, 33 to 37 weeks and X38 weeks. In each group of 60 neonates, 20 were studied on the first day after birth, 20 were studied on day 10 and 20 were studied on day 30. A multivariate analysis was performed to examine various associations with bleeding time.Result: Bleeding times, on the first day of life, were shorter as gestational age increased. Those born <33 weeks gestation had bleeding times about twice that of those X38 weeks (P<0.001). Bleeding times tended to shorten between days 1 and 10. Little or no further shortening occurred between days 10 and 30, and by day 30 they were not statistically different between the various gestational age groups. No independent effect on bleeding time could be ascribed to gender, platelet count or circulating platelet mass, but independent effects were found for hematocrit (P<0.02) and gestational age (P<0.001). Conclusion:On the first day of life, preterm neonates have a longer bleeding time than do term neonates. By day of life 10, the bleeding times at all gestational ages are shorter and are indistinguishable on the basis of gestational age at birth. Additionally, since platelet counts as low as 110 000 per microliter did not prolong the bleeding time, we see no benefit of administering a platelet transfusion to a stable, nonbleeding, NICU patient with mild thrombocytopenia (platelet count 100 000 to 150 000 per microliter).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Template bleeding times of 240 neonates born at 24 to 41 weeks gestation

et al. 2008

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“…However, transfusions unquestionably carry risks, and multiple transfusions compound these risks. [3][4][5][6][7] It is highly probable that some transfusions given to Neonatal Intensive Care Unit (NICU) patients are not necessary. Such transfusions, although ordered with good intentions, might convey no benefits to the recipient, but nevertheless carry risks.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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Objective: We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of noncompliance that could be addressed by quality improvement measures. Result: During 2006 the three NICUs cared for 1759 neonates. Seventeen percent of these received one or more (median 3) erythrocyte transfusions, 4% received one or more (median 3) platelet transfusions, 6% received one or more (median 1) FP infusions and 2% received cryoprecipitate (median 1 dose). Seventy percent of the erythrocyte transfusions were given in compliance with the guidelines, as were 69% of the platelet transfusions, 65% of the FP transfusions and 94% of the cryoprecipitate administrations. Patients who received large numbers of transfusions were more likely to receive transfusion that violated the guidelines. Forty-five percent of patients who received 1 to 3 transfusions received all transfusions within guidelines. However, only 18% of patients who received 4 to 10 transfusions received all within guidelines. No patient who received >10 transfusions received all within the guidelines. Erythrocyte transfusions given early in the hospital course were likely to be within guidelines; 72% (588/818) in the first 29 days were compliant with guidelines, but compliance fell to 61% (144/237) for transfusions administered after 29 days (P ¼ 0.002). About half of the platelet transfusions given early in the hospital course were in violation of guidelines, but after day 9, 83% of platelet transfusions were compliant with guidelines (P ¼ 0.000). Conclusion:Opportunities exist in our healthcare system to improve compliance with our transfusion guidelines. Such opportunities are greatest among neonates receiving multiple transfusions, among those receiving erythrocyte transfusions late in their NICU course and among those receiving platelet transfusions early in their NICU course.

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“…In unadjusted analyses, the risk of death was highest among neonates who received the most platelet transfusions. 8,14,[16][17][18][19]21,[23][24][25][26][27] In the only RCT, there was no difference in mortality with a platelet transfusion trigger of 50 3 10 9 /L or 150 3 10 9 /L. 8 Data synthesis.…”

Section: Critically Ill Preterm Neonatesmentioning

confidence: 99%