Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study

Abstract

<b><i>Background:</i></b> Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding. <b><i>Objectives:</i></b> The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population. <b><i>Methods:</i></b> A cross-sectional study that utilized National Inpatient Sample for the years 2000–2017 was conducted. All preterm infants delivered nationally with birth weight (BW) <1,500 g or gestational age <32 weeks were included. Analyses were repeated after stratifying the population into 2 BW subcategories <1,000 g and 1,000–1,499 g. Logistic regression analysis was performed to adjust for confounding variables. <b><i>Results:</i></b> The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in <1,000-g infants (aOR = 1.96, CI: 1.76–2.18, <i>p</i> < 0.001) and 1,000–1,499-g infants (aOR = 2.02, CI: 1.62–2.53, <i>p</i> < 0.001). Platelet transfusion increased over the years in infants with BW <1,000 g (<i>p</i> = 0.001) and in infants with BW 1,000–1,499 g (<i>p</i> < 0.001). <b><i>Conclusions:</i></b> Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.

Platelets in the neonate: Not just a small adult

“…This analysis demonstrated that neonates with the highest baseline risk of bleeding/mortality (based on accepted clinical factors such as gestational age, underlying diagnosis, etc) benefitted just as much as low‐risk neonates from the restrictive transfusion thresholds. While these findings seemed surprising at first, they were in fact consistent with several observational studies that had found a poor correlation between platelet count and bleeding risk (suggesting that factors other than platelet count are better predictors of bleeding risk in neonates), 7,11–14 no effect of platelet transfusions in reducing the incidence or severity of IVH, 8,12,15 and an association between number of platelet transfusions and increased neonatal morbidity and mortality 16–22 …”

“…While these findings seemed surprising at first, they were in fact consistent with several observational studies that had found a poor correlation between platelet count and bleeding risk (suggesting that factors other than platelet count are better predictors of bleeding risk in neonates), 7 , 11 , 12 , 13 , 14 no effect of platelet transfusions in reducing the incidence or severity of IVH, 8 , 12 , 15 and an association between number of platelet transfusions and increased neonatal morbidity and mortality. 16 , 17 , 18 , 19 , 20 , 21 , 22 …”

Platelet transfusion and mortality in patients with sepsis‐induced thrombocytopenia: A propensity score matching analysis

“…Another publication found that platelet transfusion was associated with higher risks of arterial thrombosis and mortality among thrombotic thrombocytopenic purpura (TTP) and heparin-induced thrombocytopenia (HIT) patients [29]. A crosssectional study reported that platelet transfusion was associated with increased mortality and comorbidities in premature infants with thrombocytopenia [30]. In addition, platelet transfusion rates were associated with hospital mortality (adjusted relative risk per 5 ml/kg/d increase:…”

“…Another publication found that platelet transfusion was associated with higher risks of arterial thrombosis and mortality among thrombotic thrombocytopenic purpura (TTP) and heparin‐induced thrombocytopenia (HIT) patients [29]. A cross‐sectional study reported that platelet transfusion was associated with increased mortality and comorbidities in premature infants with thrombocytopenia [30]. In addition, platelet transfusion rates were associated with hospital mortality (adjusted relative risk per 5 ml/kg/d increase: 1.12; 95% CI 1.02–1.23, p = 0.02) among neonates receiving extracorporeal membrane oxygenation (ECMO) [31].…”

Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants

“…4,5 In the US, 23% of preterm infants with thrombocytopenia received platelet transfusion. 3 However, whether these transfusions are beneficial or detrimental is still controversial.…”