Platelet transfusion practices in neonatology: A single-center observational study

Abstract

Aims: Platelet transfusions are common in the neonatal intensive care unit (NICU), yet practices vary substantially. This study aims to determine platelet transfusion incidence, determinants, and justifications in neonatology. Methods: Single-center prospective cohort study, including all patients consecutively admitted to the CHU Sainte-Justine Hospital NICU over a 5-month period in 2013. Data were collected by chart review and transfusion justifications were assessed using a questionnaire. Results: A total of 401 participants were included. Mean birth weight (BW) was 2.34±1.01 kg and gestational age (GA) was 34.4±4.5 weeks. Thirty-seven neonates (9.2%) received at least one platelet transfusion. Platelet-transfused neonates were mostly extremely preterm (40.5%) or term (24.3%). The median pre-platelet transfusion count was 57 × 109/L (9–285 × 109/L). Compared to non-transfused patients, those who received at least one platelet transfusion had a significantly lower BW and GA, higher CRIB-II and SNAPPE-II scores (all p and#60;0.001) and were more frequently admitted for respiratory disease (p and#60;0.001), hypoxic-ischemic encephalopathy (p=0.009), and hemolytic disease of the newborn (p and#60;0.001). Gestational age and#60;28 weeks (pand#60;0.001), mechanical ventilation requirements (p=0.008), and platelet nadir ≤150 × 109/L (pand#60;0.001) upon admission were independently associated with a higher risk of platelet transfusion in this cohort. Most frequent justifications for ordering a first platelet transfusion were low platelet counts (86.5%), underlying disease (78.4%) and illness severity (37.8%). Conclusion: Pre-transfusion platelet counts in neonates varied widely and were higher than the thresholds proposed in the literature. Several factors other than platelet count predicted risk of platelet transfusion in this cohort.

Platelet transfusion practice pattern before and after implementation of a local restrictive transfusion protocol in a neonatal intensive care unit

“…Table 3 summarizes the assessed determinants of platelet transfusions in the 2021 cohort. As observed with the 2013 cohort, 5 characteristics on the first day in the NICU which predicted platelet transfusion during the NICU stay in 2021 were: GA < 28 weeks, BW ≤1500 g, mechanical ventilation requirements, hemoglobin nadir ≤150 g/ L, platelet nadir ≤150 Â 10 9 /L and lactate >5 mmol/L. Non-invasive ventilation was associated with fewer platelet transfusions.…”

“…The comparison cohort used was from a different project conducted in the same NICU in 2013, prior to protocol implementation. The characteristics of this comparison cohort were published in a separate article—please refer to reference 5 for details. Setting .…”

“…A list of potential determinants of platelet transfusions in neonates was generated for the study conducted in 2013. 5 This list was created from a literature review in collaboration with local experts in neonatology and transfusion medicine. For direct comparison, the same list was used in 2021.…”

“…[2][3][4] A cohort study conducted in the Sainte-Justine Hospital NICU showed a wide disparity in platelet transfusion practices among local practitioners, with several factors besides platelet count influencing transfusion decisions. 5 Current literature advocates for standardizing neonatal platelet transfusion practice by adopting and adhering to transfusion protocols. 6 Whereas until recently equipoise existed between the clinical repercussions of liberal versus restrictive platelet transfusion thresholds in the NICU, the multicenter randomized controlled trial PlaNeT-2 demonstrated increased survival and decreased major bleeding, including intraventricular hemorrhage (IVH), in preterm neonates transfused at a platelet threshold of 25 versus 50 Â 10 9 /L.…”

“…The threshold for platelet transfusion is a matter of debate, with striking variation in transfusion practices among neonatologists 2–4 . A cohort study conducted in the Sainte‐Justine Hospital NICU showed a wide disparity in platelet transfusion practices among local practitioners, with several factors besides platelet count influencing transfusion decisions 5 . Current literature advocates for standardizing neonatal platelet transfusion practice by adopting and adhering to transfusion protocols 6 .…”