Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada

Keir, Amy; Yang, Junmin; Harrison, Adele; Pelausa, Ermelinda; Shah, Prakesh S.

doi:10.1111/trf.12998

Cited by 74 publications

(61 citation statements)

References 30 publications

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“…These transfusion rates are consistent with other studies reporting red blood cell transfusions in 50–61% of neonates <32 weeks' gestation 4 18 with higher rates (>85%) reported among neonates of birth weight <1000 g, even with restrictive transfusion thresholds 5–7…”

Section: Discussionsupporting

confidence: 91%

“…Previous reports of transfusion practices in neonates have predominantly studied patients admitted to a neonatal intensive care unit (NICU), with most studies focusing on transfusions in premature or very low birthweight neonates 2 4 5. Neonates born at term gestation or cared for in hospitals without an NICU may also require blood transfusions for reasons including antenatal or postnatal blood loss, hereditary blood disorders, haemolysis or need for major surgery; however, the rates of transfusion for neonates with these problems have not been well documented.…”

Section: Introductionmentioning

confidence: 99%

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Red cell and platelet transfusions in neonates: a population-based study

Bowen

Patterson

Roberts

et al. 2015

Arch Dis Child Fetal Neonatal Ed

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Red cell and platelet transfusions in neonates: a population-based study

Bowen

Patterson

Roberts

et al. 2015

Arch Dis Child Fetal Neonatal Ed

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show abstract

“…This may demonstrate a change in practice reflecting clinicians now having a higher threshold for transfusion for those slightly more mature preterm infants [3]. …”

Section: Thresholds Of Blood Transfusionmentioning

confidence: 99%

“…Considerable advances in Neonatology over the last 2 decades have resulted in an increased survival of preterm infants [1] and consequently the incidence of transfusions has increased exponentially [2], especially in very immature infants (23–25 weeks of gestation) [3]. Overall since the 1990s to date it has been reported that up to 90% of extremely low birth weight (ELBW) infants and 58% of preterm infants < 32 weeks of gestational age receive red blood cell transfusions (RBCT) [2-4], mainly due to iatrogenic phlebotomy losses and ventilatory requirements.…”

Section: Introductionmentioning

confidence: 99%

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

2018

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The current evidence regarding the indication, advantages and risks of red blood cell transfusion (RBCT) for preterm infants is discussed. This is an important area in Neonatology to be examined given that 90% of extremely low birth weight infants receive RBCT and many controversies remain regarding when to transfuse and the risks of RBCT. The various treatment thresholds and guidelines used are presented and we compare the short-term clinical benefits of liberal and restrictive RBCT in preterm infants; the majority of these are equivocal and sadly long-term outcome data is limited. The latest evidence on how anaemia and blood transfusion affect organ perfusion in preterm infants is presented. This is important when trying to establish the optimal trigger threshold for RBCT in preterm infants, especially because the knowledge about the adaptive physiological responses to anaemia in very low birth weight infants and the effects of RBCT at various levels of anaemia is also inadequate. Further research into the physiological adaptive response to anaemia of varying degrees and to RBCT at different levels of anaemia in preterm infants of different gestational and post-natal ages is needed before we can conclusively guide the optimal timing and trigger thresholds for RBCT in preterm infants.

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“…Although there are many strategies to minimize the depth of anemia, the majority of very preterm newborns still receive a packed red blood cell transfusion to increase oxygen carrying capacity. 23 Typically, transfusion is determined from an algorithm designed on [Hb]/ hematocrit thresholds and modified by chronologic age and the need for respiratory support. The current recommendations are based on a small number of randomized trials.…”

Section: Co and Changes In Systemic Hemodynamics After Deliverymentioning

confidence: 99%

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

et al. 2017

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John Scott Haldane recognized that the administration of supplemental oxygen required titration in the individual. Although he made this observation in adults, it is equally applicable to the preterm newborn. But how, in practice, can the oxygen requirements in the preterm newborn be determined to avoid the consequences of too little and too much oxygen? Unfortunately, the current generation of oxygen saturation trials in preterm newborns guides saturation thresholds rather than individual oxygen requirements. For this reason, we propose an alternate model for the description of oxygen sufficiency. This model considers the adequacy of oxygen delivery relative to simultaneous consumption. We describe how measuring oxygen extraction or the venous oxygen reservoir could define a physiologically based definition of adequate oxygen. This definition would provide a clinically useful reference value while making irrelevant the absolute values of both oxygen delivery and consumption. Additional trials to test adjunctive, noninvasive measurements of oxygen status in high-risk preterm newborns are needed to minimize the effects of both insufficient and excessive oxygen exposure.

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Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada

Cited by 74 publications

References 30 publications

Red cell and platelet transfusions in neonates: a population-based study

Red cell and platelet transfusions in neonates: a population-based study

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

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

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