Transfusion practices in a neonatal intensive care unit in a city in Brazil

Abstract

ObjectiveNewborn infants are the most heavily transfused population inside intensive care units. The hemoglobin level used to indicate the need of transfusions is not well established. The aim of this study was to evaluate transfusional practices in newborns in the neonatal intensive care units of one specific city.MethodsRed blood cell transfusion practices of all transfused newborns in all five of the neonatal intensive care units of the city were analyzed. Data are reported as descriptive statistics, including numbers and percentages and means and standard deviation. Univariate analysis, followed by stepwise logistic regression was performed in respect to transfusional data and outcomes.ResultsA total of 949 patients were admitted to the intensive care units during the 12-month study period with 20.9% receiving at least one transfusion, most (62.4%) of whom received more than one transfusion. The mean number of transfusions per infant was 2.7 ± 2.16; in the liberal transfusion group the mean number was 1.59 ± 1.63 and in the restrictive group it was 1.08 ± 1.51. The mean hemoglobin and hematocrit levels were 9.0 g/dL (±1.4 g/dL) and 27.4% (±4.3%), respectively. The most common indications for blood transfusions were sepsis and prematurity.ConclusionThis study shows that the characteristics and the transfusion practices for newborns admitted in the neonatal intensive care units of Juiz de Fora are similar to recent pubications. There was no significant reduction in the number of transfusions per child in the restrictive group compared to the liberal group. Restrictive transfusions are an independent risk factor for peri-intraventricular hemorrhages and death.

Comment on: Transfusion practices in a neonatal intensive care unit in a Brazilian town

“…In this issue of the Revista Brasileira de Hematologia e Hemo-terapia , Portugal et al 2 analyzed the transfusion practices in five neonatal intensive care units (NICUs) in Juiz de Fora, MG, Brazil. The analysis of transfusion rates and factors associated with RBC transfusions in neonates is essential to monitor transfusion compliance guidelines.…”

“…The study of Portugal et al 2 is a retrospective investigation that included neonates admitted to NICUs who received at least one packed RBC transfusion, regardless of their gestational age or birth weight. Data related to the 12-month study period were collected by chart reviews and RBC transfusions were classified as liberal or restrictive according to the criteria of the 2011 Cochrane database for systematic reviews.…”

“…The final model of logistic regression analysis of independent variables (pre-transfusion hemoglobin and hematocrit values, mean number of transfusions per newborn, and liberal and restrictive groups) showed that intraventricular hemorrhage [ODDS ratio (OR): 2.04; 95% confidence interval (95% CI): 1.05–3.95; p -value = 0.033] and death (OR: 2.57; 95% CI: 1.30–5.09; p -value = 0.007) were associated with the restrictive guidelines. 2 This result may be due to the choice of variables for the logistic regression model.…”

“…Most published studies related to transfusion practices in neonatal units included very low and/or extremely low birth weight preterm infants. However, Portugal et al 2 studied neonates regardless of their gestational age and birth weight, which is also very interesting. However, this approach makes data analysis more difficult because the restrictiveness of transfusion guidelines described by Robin and Kirpalani, 4 which were adopted in this study, were designed for very low birth weight preterm infants and not for those born at full term.…”

“…The inclusion of full term neonates may explain some controversial results found by these authors. 2 It is possible that the restrictive character of transfusion guidelines is not the same for neonates of different gestational ages and birth weight. Moreover, the retrospective design, the low number of transfused neonates included in the study and the absence of non-transfused patients could also have contributed to the results of this research.…”