Predictive factors and practice trends in red blood cell transfusions for very-low-birth-weight infants

Abstract

Background Red blood cell (RBC) transfusions in very low birthweight (VLBW) infants, while common, carry risk. Our objective was to determine clinical predictors of and trends in RBC transfusions among VLBW infants. Methods RBC transfusion practice and its clinical predictors in 1,750 VLBW (≤1500 g) infants were analyzed in a single-center cohort across sequential epochs: 2000–2004 (Epoch 1), 2005– 2009 (Epoch 2), and 2010–2013 (Epoch 3). Results Overall, 1,168 (67 %) infants received ≥1 transfusions. The adjusted likelihood of ≥1 transfusions decreased for each 1-g/dL increment in initial hemoglobin concentration following birth, for females, and for each 100-g increment in birthweight. The adjusted likelihood of ≥1 transfusions increased with infants receiving mechanical ventilation, with increasing length of hospital stay, with necrotizing enterocolitis and with non-lethal congenital anomalies requiring surgery. The adjusted mean (SEM) number of transfusions per patient was decreased in Epoch 3, compared with Epoch 1 and Epoch 2. For an initial hemoglobin of ≥16.5 g/dL, the predicted probability of being transfused was ≤50%. Conclusion Adjusted RBC transfusions declined and female sex conferred an unexplained protection over the study period. Modest increases in initial hemoglobin by placentofetal transfusion at delivery may reduce the need for RBC transfusion.

Optimizing Measurement of Vascular Endothelial Growth Factor in Small Blood Samples of Premature Infants

“…Therefore, the concentrations of systemic VEGF and other angiogenic cytokines have been evaluated in a variety of different set-ups with the intention to identify either systemic predictors of pathogenic retinal angiogenesis or changes in expression of such factors as a consequence of systemic VEGF-blockage by intravitreal anti-VEGF therapy 9–14 . However, repeated phlebotomy loss in the first weeks of life is one of the major causes of iatrogenic anaemia, and can significantly contribute to the exposure to red blood cells transfusions 15,16 .…”

Epidemiology of Necrotizing Enterocolitis

“…Temporal trends suggest increasingly restrictive RBC transfusion practices, with acceptance of a lower concentration of Hb before a RBC transfusion [14][15][16] . In the absence of a clear advantage of either approach, the optimal Hb transfusion threshold remains uncertain with a recent Cochrane review justifying clinical equipoise 17 .…”

Transfusion practice in neonates

“…Taken together, a metaanalysis in 2011 including a long-term study by Whyte et al [ 33 ] showed the following findings: (1) the restrictive group received fewer transfusions and lowered donor exposures than the liberal group, (2) there were no differences between both groups in the rate of mortality and serious morbidity at discharge, and (3) there were no differences between both groups at 18 to 21 months of corrected age in mortality, major morbidity, and serious neurodevelopmental impairment [ 34 ]. Based on these findings, use of the restrictive strategy is preferred to decrease exposure to transfusions [ 35 ]. Transfusion should be carefully determined by comparing the anticipated effects and risks according to the clinical condition as well as the hematocrit level.…”