Survey of transfusion practices in preterm infants in Europe

Abstract

BackgroundPreterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data.MethodsFrom October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries.ResultsResponses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×109/L in non-bleeding infants of GA of <28 weeks, while the 25×109/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs.ConclusionsTransfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice.

Frequency of red blood cell transfusions in preterm neonates in Brazil: A systematic review and meta‐analysis

“…We do not think that these differences impaired the achievement of an overall point estimate for the frequency of these transfusions, and we know that these transfusion practices vary, so we aimed to include all the frequencies. Noteworthy, a survey that investigated transfusion practices and included 343 neonatal intensive care units revealed that transfusion thresholds and aspects of administration varied widely across Europe [23]. In the present review, only three studies reported the mean volume transfused per infant, which ranged from 20.9 to 36 mL/kg.…”

“…To the best of our knowledge, this is the first meta-analysis to estimate the frequency of RBC transfusions in preterm neonates in Brazil. This study included a quality assessment evaluation, and we consider this a strength, as few meta-analyses of prevalence analyse the quality of evidence [23].…”

Erythrocyte transfusions are associated with retinopathy of prematurity in extremely low gestational age newborns

“…22 Despite the propagation of anaemia preventing practices, 26,27 RBC transfusions are still very common especially in very premature infants. 13 Only recently, a survey of transfusion practices in Europe documented highly variable practices and a tendency towards liberal transfusion thresholds 13 -despite data from randomised controlled trials supporting more restrictive thresholds. [28][29][30] Liberal thresholds did not reduce the likelihood of preterm morbidity until discharge or death and disability at 24 months corrected age.…”

“…3,[8][9][10][11][12] And yet, preterm infants, especially those born very prematurely, frequently receive RBC transfusions during their neonatal intensive care units (NICUs) stay. 13 In the present study, we performed a series of analyses in the German Neonatal Network (GNN) data set. We tested the hypothesis that extremely low gestational age newborns (ELGANs) with a history of one or more RBC transfusions are more likely to develop either any ROP or progression to higher stage disease or treatment-warranted ROP.…”

“…There is increasing evidence that red blood cell (RBC) transfusions may represent an independent risk factor for ROP development 3,8–12 . And yet, preterm infants, especially those born very prematurely, frequently receive RBC transfusions during their neonatal intensive care units (NICUs) stay 13 . In the present study, we performed a series of analyses in the German Neonatal Network (GNN) data set.…”