Patterns of phlebotomy blood loss and transfusions in extremely low birth weight infants

Puia‐Dumitrescu, Mihai; Tanaka, David; Spears, Tracy; Daniel, Cecil J; Kumar, Karan; Athavale, Kamlesh; Juul, Sandra E.; Smith, P. Brian

doi:10.1038/s41372-019-0515-6

Cited by 22 publications

(29 citation statements)

References 30 publications

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“…Despite this variation, the vast majority of extremely low gestational age neonates (ELGANs, <28 weeks’ gestation) receive at least 1 pRBC transfusion, with the median number ranging from 3 to 8 during their hospitalization, the majority of which occur in the first month after birth. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

“…Despite this variation, the vast majority of extremely low gestational age neonates (ELGANs, <28 weeks' gestation) receive at least 1 pRBC transfusion, with the median number ranging from 3 to 8 during their hospitalization, the majority of which occur in the first month after birth. 1,2 A better understanding of the potential risks and benefits associated with pRBC transfusions is needed to help guide appropriate transfusion practices in the NICU. Potential shortterm risks include infection, inflammation, transfusion-related lung injury, and transfusion-related necrotizing enterocolitis.…”

Section: Introductionmentioning

confidence: 99%

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Transfusions and neurodevelopmental outcomes in extremely low gestation neonates enrolled in the PENUT Trial: a randomized clinical trial

Ohls

Mayock

et al. 2021

Pediatr Res

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and for the PENUT Consortium BACKGROUND: Outcomes of extremely low gestational age neonates (ELGANs) may be adversely impacted by packed red blood cell (pRBC) transfusions. We investigated the impact of transfusions on neurodevelopmental outcome in the Preterm Erythropoietin (Epo) Neuroprotection (PENUT) Trial population. METHODS: This is a post hoc analysis of 936 infants 24-0/6 to 27-6/7 weeks' gestation enrolled in the PENUT Trial. Epo 1000 U/kg or placebo was given every 48 h × 6 doses, followed by 400 U/kg or sham injections 3 times a week through 32 weeks postmenstrual age. Six hundred and twenty-eight (315 placebo, 313 Epo) survived and were assessed at 2 years of age. We evaluated associations between BSID-III scores and the number and volume of pRBC transfusions. RESULTS: Each transfusion was associated with a decrease in mean cognitive score of 0.96 (95% CI of [−1.34, −0.57]), a decrease in mean motor score of 1.51 (−1.91, −1.12), and a decrease in mean language score of 1.10 (−1.54, −0.66). Significant negative associations between BSID-III score and transfusion volume and donor exposure were observed in the placebo group but not in the Epo group. CONCLUSIONS: Transfusions in ELGANs were associated with worse outcomes. We speculate that strategies to minimize the need for transfusions may improve outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transfusions and neurodevelopmental outcomes in extremely low gestation neonates enrolled in the PENUT Trial: a randomized clinical trial

Ohls

Mayock

et al. 2021

Pediatr Res

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“…Blood loss due to sampling is considered a major cause of anemia in preterm infants. In fact, during the first weeks of life, extracted blood volume in critically sick neonates may be as much as 58% of the total blood volume [ 7 – 9 ]. In extremely premature infants, there is a speculated association between blood loss-induced anemia and both NEC [ 10 ] and BPD development [ 9 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Interventions to minimize blood loss in very preterm infants—A systematic review and meta-analysis

et al. 2021

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Blood loss in the first days of life has been associated with increased morbidity and mortality in very preterm infants. In this systematic review we included randomized controlled trials comparing the effects of interventions to preserve blood volume in the infant from birth, reduce the need for sampling, or limit the blood sampled. Mortality and major neurodevelopmental disabilities were the primary outcomes. Included studies underwent risk of bias-assessment and data extraction by two review authors independently. We used risk ratio or mean difference to evaluate the treatment effect and meta-analysis for pooled results. The certainty of evidence was assessed using GRADE. We included 31 trials enrolling 3,759 infants. Twenty-five trials were pooled in the comparison delayed cord clamping or cord milking vs. immediate cord clamping or no milking. Increasing placental transfusion resulted in lower mortality during the neonatal period (RR 0.51, 95% CI 0.26 to 1.00; participants = 595; trials = 5; I2 = 0%, moderate certainty of evidence) and during first hospitalization (RR 0.70, 95% CI 0.51, 0.96; 10 RCTs, participants = 2,476, low certainty of evidence). The certainty of evidence was very low for the other primary outcomes of this review. The six remaining trials compared devices to monitor glucose levels (three trials), blood sampling from the umbilical cord or from the placenta vs. blood sampling from the infant (2 trials), and devices to reintroduce the blood after analysis vs. conventional blood sampling (1 trial); the certainty of evidence was rated as very low for all outcomes in these comparisons. Increasing placental transfusion at birth may reduce mortality in very preterm infants; However, extremely limited evidence is available to assess the effects of other interventions to reduce blood loss after birth. In future trials, infants could be randomized following placental transfusion to different blood saving approaches. Trial registration: PROSPERO CRD42020159882.

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“…Neonatal blood volume can be preserved by sparse blood sampling for diagnostic purposes. Iatrogenic neonatal blood loss in association with blood sampling [6][7][8][9][10][11][12][13] has been an issue for decades. Several studies have actually quantified the iatrogenic blood loss in VLBW neonates [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Iatrogenic neonatal blood loss in association with blood sampling [6][7][8][9][10][11][12][13] has been an issue for decades. Several studies have actually quantified the iatrogenic blood loss in VLBW neonates [6][7][8][9][10][11]. The amount of blood taken from ELBW and VLBW infants during the first 28 days of life has been reported as 31 mL/kg body weight in 1981 [6], 50.3 mL/kg body weight [7] in 1988, and 24.2 mL/kg body weight in 2019 [8].…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic Blood Loss in Very Low Birth Weight Infants and Transfusion of Packed Red Blood Cells in a Tertiary Care Neonatal Intensive Care Unit

Aboalqez¹,

Deindl²,

Ebenebe³

et al. 2021

Children

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An adequate blood volume is important for neonatal adaptation. The study objective was to quantify the cumulative iatrogenic blood loss in very low birth weight (VLBW) infants by blood sampling and the necessity of packed red cell transfusions from birth to discharge from the hospital. In total, 132 consecutive VLBW infants were treated in 2019 and 2020 with a median birth weight of 1180 g (range 370–1495 g) and a median length of stay of 54 days (range 0–154 days) were included. During the initial four weeks of life, the median absolute amount of blood sampling was 16.5 mL (IQR 12.3–21.1 mL), sampling volume was different with 14.0 mL (IQR 12.1–16.2 mL) for non-transfused infants and 21.6 mL (IQR 17.5–29.4 mL) for transfused infants. During the entire length of stay, 31.8% of the patients had at least one transfusion. In a generalized logistic regression model, the cumulative amount of blood sampling (p < 0.01) and lower hematocrit at birth (p = 0.02) were independent predictors for the necessity of blood transfusion. Therefore, optimized patient blood management in VLBW neonates should include sparse blood sampling to avoid iatrogenic blood loss.

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Patterns of phlebotomy blood loss and transfusions in extremely low birth weight infants

Cited by 22 publications

References 30 publications

Transfusions and neurodevelopmental outcomes in extremely low gestation neonates enrolled in the PENUT Trial: a randomized clinical trial

Transfusions and neurodevelopmental outcomes in extremely low gestation neonates enrolled in the PENUT Trial: a randomized clinical trial

Interventions to minimize blood loss in very preterm infants—A systematic review and meta-analysis

Iatrogenic Blood Loss in Very Low Birth Weight Infants and Transfusion of Packed Red Blood Cells in a Tertiary Care Neonatal Intensive Care Unit

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