Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies

Howarth, Claire; Banerjee, Jayanta; Aladangady, Narendra

doi:10.1159/000486584

Cited by 124 publications

(142 citation statements)

References 78 publications

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“…Randomised trials comparing targeting more restrictive versus more liberal Hb concentrations (about 1–2 g/dL lower) result in reduced need for blood transfusion without affecting hospital outcomes, and recent British Committee for Standards in Haematology based their thresholds on these more restrictive thresholds [184]. However post hoc analysis of long-term follow-up data from one study showed some better cognitive outcomes in those with more liberal Hb thresholds highlighting the need for further studies in this area [185, 186]. It remains unclear whether a liberal or restrictive transfusion policy is best.…”

Section: Managing Blood Pressure and Perfusionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Managing Blood Pressure and Perfusionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…At least 40% of very low‐birth‐weight infants (<1500 g at birth) and about 90% of extremely low‐birth‐weight infants (<1000 g at birth) require at least one RBC transfusion during their hospitalization, related to phlebotomy losses and an exaggerated postnatal nadir of anemia . Exposure to prolonged anemia may have detrimental consequences on the preterm infant, contributing to complications related to prematurity and poor growth . Conversely, RBC transfusions are not without risks, including potential associations with necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, and adverse long‐term neurodevelopmental outcomes .…”

mentioning

confidence: 99%

“…Additionally, preterm infants with anemia extract more oxygen compared to non‐anemic preterm infants . Research delineating Hct threshold for optimal improvement in oxygen extraction following RBC transfusion is needed . In this study, we seek to determine the impact of feeding and anemia status on cerebral and mesenteric oxygenation and oxygen extraction response to RBC transfusion in preterm infants.…”

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confidence: 99%

Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants

et al. 2020

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BACKGROUND Understanding factors that impact tissue oxygen extraction may guide red blood cell (RBC) transfusion decision making in preterm infants. Our objective was to assess the influence of enteral feeding and anemia on cerebral and mesenteric oxygen saturation (Csat and Msat) and fractional tissue oxygen extraction (cFTOE and mFTOE) over the entire time course of RBC transfusion. STUDY DESIGN AND METHODS Preterm, very low‐birth‐weight infants receiving RBC transfusions at a single center were enrolled. Near‐infrared spectroscopy sensors measured Csat and Msat levels from an hour before transfusion to 24 hours after. During this period, changes in Csat, Msat, cFTOE, and mFTOE were described, and their association with enteral feeding status and pretransfusion degree of anemia were assessed using generalized estimating equations. RESULTS RBC transfusion data from 31 preterm infants were included. Infants receiving enteral feeds exhibited lower pretransfusion Msat. Infants with pretransfusion hematocrit greater than 30% exhibited higher pretransfusion Csat and lower pretransfusion cFTOE. Such differences in baseline measurements persisted through 24 hours after transfusion. However, no statistically significant differences in oxygenation measures over time by enteral feeding or anemia status were identified. CONCLUSION Compared to NPO, enteral feeding was associated with lower Msat; anemia (hematocrit ≤30%) was associated with lower Csat and higher cFTOE. Over the time course of RBC transfusion, trajectories of Csat, Msat, cFTOE and mFTOE did not differ by enteral feeding or anemia status.

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“…Preterm neonates account for the highest transfusion rate and are the most challenging to determine the risk benefit ratio of blood transfusion. Expert opinion favoring a more liberal approach in preterm neonates, suggests that liberal transfusion thresholds may favor improved neurodevelopmental outcomes . Until safety can be concluded by recent ongoing trials (clinical trials.gov NCT01702805 and NCT01393496) the indications for red cell transfusion in the premature and low birth weight neonate remain challenging.…”

Section: Standard 13 Guidence Patient Blood Management For Pediatricmentioning

confidence: 99%

“…Initial laboratory testing may be performed on a cord blood sample as one strategy to decrease phlebotomy blood losses. Red blood cell transfusions when indicated should be single donor, leukocyte depleted, irradiated and fresh …”

Section: Standard 13 Guidence Patient Blood Management For Pediatricmentioning

confidence: 99%

Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

Goobie¹,

Gallagher²,

Gross

et al. 2019

Pediatric Anesthesia

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Summary Patient Blood Management is the timely application of evidence‐based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Conceptually similar to a “bundle” strategy, it is designed to improve clinical care using comprehensive evidence‐based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal‐directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. Allogeneic blood component transfusion is one traditional therapeutic modality out of many for managing blood loss and anemia and, while it may be the best choice in certain situations, other effective and more appropriate options are available and should be used in conjunction or alone. Therefore, comprehensive Patient Blood Management is the new standard of care to prevent and manage anemia and optimize hemostasis and has been recommended by the World Health Organization, the American Society of Anesthesiologists, the European Society of Anaesthesiology and the Australian National Blood Authority. While there is a plethora of expert consensus and good practice guidelines published for blood component transfusion from multiple professional organizations and societies, there remains a need for more comprehensive and broader standards of patient medical management to proactively reduce the risk of exposure to allogeneic transfusions. In 2010, the Society for Advancement of Blood Management published the first comprehensive standards to address the administrative and clinical components of an effective, patient‐centered Patient Blood Management program. Recognizing the need to reduce inappropriate transfusions, some professional organizations have placed their emphasis on transfusion guidelines. In contrast, the focus of the Society for Advancement of Blood Management Standard is on the centrality of the patient and the full spectrum of therapeutic strategies needed to improve clinical outcomes in patients at risk for blood loss or anemia, thereby reducing avoidable transfusions as well. The Standards are meant not to replace, but to complement transfusion guidelines by more completely addressing the need for a multi‐modal clinical approach with the goal to improve patient outcomes. Compared to adult programs, Pediatric Patient Blood Management programs are currently not commonly accepted as standard of care for pediatric patients. This is partly due to the fact that, until recently, there was a paucity of robust evidence‐based literature and expert consensus guidelines on pediatric PBM. Managing pediatric bleeding and blood product transfusion presents a unique set of challenges. The main goal of transfusion is to correct or avoid imminent inadequate oxygen c...

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Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies

Cited by 124 publications

References 78 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants

Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

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