Recent advances toward defining the benefits and risks of erythrocyte transfusions in neonates

Christensen, Robert D.; Ilstrup, Sarah J.

doi:10.1136/archdischild-2011-301265

Cited by 25 publications

(23 citation statements)

References 100 publications

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“…Meta‐analyses of studies that included a comparator group did not identify any consistent differences in mortality during initial hospitalization, CLD, NEC, IVH and bacterial contamination/sepsis between neonates exposed to higher or lower volumes of RBC transfusions, in either randomized or nonrandomized studies. These findings are contrary to current opinion about the risks of transfusion in the neonatal population . Reason may include limitations of much of the primary study evidence, which the systematic review is based on, needs to be acknowledged.…”

Section: Adverse Effects and Associations Of Neonatal Rbc Transfusioncontrasting

confidence: 60%

The practice of transfusion and fluid bolus therapy in neonates

Keir

Stanworth

2018

ISBT Science Series

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There is increasing uncertainty over the potential benefits and harms of volume expansion in paediatric and adult critical care settings. In addition, there are increasing numbers of reports of adverse effects and association with RBC transfusions in neonates, including transfusion‐associated necrotizing enterocolitis. Preterm infants <28 weeks’ gestation in particular are likely more vulnerable to volume shifts and changes in blood pressure due to their unique physiology. This review paper will provide an overview of the current evidence base supporting the use of RBC transfusion thresholds and the use of fluid bolus therapy in neonates. We will argue that enhanced data collection and collaborations through neonatal networks, development of international consensus definitions of transfusion adverse effects and associations, as well as haemodynamic compromise in neonates, are needed to further advance research in these areas.

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Section: Adverse Effects and Associations Of Neonatal Rbc Transfusioncontrasting

confidence: 60%

The practice of transfusion and fluid bolus therapy in neonates

Keir

Stanworth

2018

ISBT Science Series

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“…Although potentially lifesaving, blood transfusions are associated with risks in the NICU[7,8]. Several studies have attempted to better define indications for transfusion in NICU babies[24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have attempted to better define indications for transfusion in NICU babies[24,25]. Previous investigations have sought to develop transfusion protocols, to achieve an acceptable balance between the risks and the benefits of transfusing preterm infants[1,7,25]. The PINT trial concluded that a higher hemoglobin threshold for transfusions in the NICU resulted in a greater number of transfusions without any added benefit, when compared to a restricted hemoglobin threshold[26].…”

Section: Discussionmentioning

confidence: 99%

“…Although PRBC transfusions are believed to be helpful in the NICU[6], they have been implicated in the development of bronchopulmonary dysplasia, acute lung injury, necrotizing enterocolitis (NEC), intraventricular hemorrhage, and retinopathy of prematurity[7,8]. Multiple transfusions may result in iron deposition leading to dysfunction in the liver, heart and other organs[9-14].…”

Section: Introductionmentioning

confidence: 99%

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Packed red blood cell transfusions as a risk factor for parenteral nutrition associated liver disease in premature infants

D’Souza¹,

Algotar²,

Pan³

et al. 2016

WJCP

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AIMTo determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease.METHODSA retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell (PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin (db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells (the median value). Kaplan-Meier plots estimated the median volume of packed red blood cells received in order to develop parenteral nutrition associated liver disease.RESULTSParenteral nutritional associated liver disease (PNALD) was noted in 21 (43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17 (64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.CONCLUSIONIn this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.

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“…Most of the current transfusion guidelines are not evidence based. Many institutions have designed protocols using a combination of criteria such as infant's health status, physiological needs, need for oxygen, respiratory support, clinical signs, and laboratory parameters [6]. Two published trials [7,8] showed conflicting results, which added to the physician's dilemma.…”

Section: Treatmentmentioning

confidence: 99%

“To Transfuse or Not to Transfuse”-A Neonatologist’s Daily Dilemma

ayal¹

2016

J Hematol Thrombo Dis

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Evidence based guidelines for the neonatal transfusions are still emerging. It is always a conundrum for a pediatrician, to decide when to give packed red blood cells to a growing premature infant with or without signs and symptoms of chronic neonatal anemia. It is further complicated, as some of that clinical picture can be explained by co-morbidities like neonatal sepsis, apnea of prematurity and caffeine therapy. So, that physician needs to weigh the risks and benefits for such seemingly benign procedure and also rule out conditions that can mimic the signs and symptoms of anemia of prematurity.Here, an attempt was made to provide suggestions for giving neonatal transfusion, using an algorithm approach. A review of recent literature was done and a short review was provided.

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Recent advances toward defining the benefits and risks of erythrocyte transfusions in neonates

Cited by 25 publications

References 100 publications

The practice of transfusion and fluid bolus therapy in neonates

The practice of transfusion and fluid bolus therapy in neonates

Packed red blood cell transfusions as a risk factor for parenteral nutrition associated liver disease in premature infants

“To Transfuse or Not to Transfuse”-A Neonatologist’s Daily Dilemma

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