International Survey of Transfusion Practices for Extremely Premature Infants

Abstract

Our objective was to survey neonatologists regarding international practice of red cell transfusion thresholds for premature infants with <1000-g birth weight and/or <28-week gestation. An invitation to fill out an 11-question web-based survey was distributed to neonatologists through their professional societies in 22 countries. Physicians were asked about which specific factors, in addition to hemoglobin levels, influenced their decisions about transfusing premature infants. These factors included gestational age, postnatal age, oxygen need, respiratory support, reticulocyte count, and inotropic support. Physicians were presented with 5 scenarios and asked to identify hemoglobin cutoff values for transfusing infants with <1000-g birth weight and/or <28-week gestation. One thousand eighteen neonatologists responded: the majority were from the United States (67.5%), followed by Germany (10.7%), Japan (8.0%), the United Kingdom (4.9%), Spain (3.9%), Italy (2.6%), Colombia (0.6%), Argentina (0.4%), Canada (0.4%), Belgium (0.1%), and the Netherlands (0.1%). Half of the respondents (51.1%) reported having a written policy with specific red cell transfusion guidelines in their unit. Factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement (44.7%) and need for respiratory support (44.1%). Erythropoietin was routinely used to treat anemia by 26.0% of respondents. Delayed cord clamping or cord milking was practiced by 29.1% of respondents. The main finding was of a wide variation in the hemoglobin values used to transfuse infants, regardless of postnatal age. Step-wise increments in the median hemoglobin cutoffs directly paralleled an increase in the need for levels of respiratory support. In the first week of life, there was a wider range in the distribution of hemoglobin transfusion thresholds for infants requiring no respiratory support and full mechanical ventilation compared with the thresholds used in the second, third, and fourth weeks of life. An international survey using hypothetical scenarios shows that red blood cell transfusion practices vary widely among practicing neonatologists in participating countries.

Red cell and platelet transfusions in neonates: a population-based study

“…Previous reports of transfusion practices in neonates have predominantly studied patients admitted to a neonatal intensive care unit (NICU), with most studies focusing on transfusions in premature or very low birthweight neonates 2 4 5. Neonates born at term gestation or cared for in hospitals without an NICU may also require blood transfusions for reasons including antenatal or postnatal blood loss, hereditary blood disorders, haemolysis or need for major surgery; however, the rates of transfusion for neonates with these problems have not been well documented.…”

Variation in NICU Admission Rates Without Identifiable Cause

“…Variability has been shown in provision of transfusions, respiratory care, and discharge policies. [7][8][9][10] Our study has a number of other important limitations. Although we obtained the potential causes through chart abstraction, inadequate chart documentation and chartspecific extraction may account for some degree of unexplained variation.…”

Anaemia in the Premature Infant and Red Blood Cell Transfusion: New Approaches to an Age-Old Problem

“…This is most likely due to the fact that there is no universally accepted haemoglobin (Hb) transfusion threshold nor agreement on a working definition of anaemia of prematurity in the preterm infant [2][3][4]. This may explain the limited high-quality evidence available regarding the benefits and potential harms of RBC transfusion in this population [5].…”