Variations in blood transfusions among newborn intensive care units

Bednarek, Francis J.; Weisberger, Stuart; Richardson, Douglas K.; Frantz, Ivan D.; Shah, Bhavesh; Rubin, Lewis P.

doi:10.1016/s0022-3476(98)70097-6

Cited by 139 publications

(72 citation statements)

References 26 publications

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“…The developing brain of a preterm infant is more vulnerable to the adverse effects of lead exposure as compared to term infants and children; especially since there is growing evidence that there may be no safe lead level (9-11) Even trace amounts of lead exposure in animal models have been shown to impact optimal neurite growth (12). Additionally, preterm infants are also at increased risk for anemia of prematurity and may receive multiple packed red blood cell (pRBC) transfusions during their stay in the neonatal intensive care units with wide variations in guidelines between neonatal intensive care units (13)(14)(15)(16). The pRBC transfusions may thus potentially increase delivery of lead to the preterm infants from the donor pRBC aliquots.…”

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confidence: 99%

Lead exposure in preterm infants receiving red blood cell transfusions

et al. 2015

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Background: Preterm infants may inadvertently be exposed to lead from the packed red blood cell (pRBC) transfusions with almost no or very limited data available. The aim of the study was to quantify this exposure in preterm infants ≤30 wk gestational age (GA). Methods: Prospective cohort study, infants ≤30 wk GA were eligible, infants < 23 wk GA and known chromosomal diseases were excluded. Blood lead levels (BLLs) were obtained at birth, before and after each transfusion, and at discharge. BLLs were also obtained from the donor pRBC aliquot transfused. A linear mixed model analysis was done. results: Of 75 infants, 34 received a total of 126 pRBC transfusions. Each infant had an average of 3.7 transfusions. 92% of lead levels in the transfused aliquot were ≤ 5 mcg/dl, 6.8% were between 6-8 mcg/dl and 1 had a level of 56 mcg/ dl. Average total lead load was 1.3 mcg/dl. For each 1 mcg/dl increase in transfused pRBC lead level, infant's post-transfusion BLL increased by 0.20 mcg/dl (95% CI: 0.07 mcg/dl, 0.33 mcg/ dl; P = 0.002), adjusting for GA and birth weight. There was no significant increase in discharge BLLs, which were similar for both transfused and nontransfused infants. conclusion: Post-transfusion infant BLLs correlate significantly with the transfused pRBCs lead level.

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confidence: 99%

Lead exposure in preterm infants receiving red blood cell transfusions

et al. 2015

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“…These scoring systems help in predicting mortality and morbidity [20] and thereby can guide us in optimizing the limited health-care resources available in our country. There are various scores devised for neonates in medical literature [21] which includes CRIB [22], CRIB II [23], APACHE, SNAP [22], SNAP II [24], SNAP-PE, SNAPPE-II [25], NTISS [26], Berlin score, NICHHD [27] score; NMPI,NEO-MOD [28]. The choice of which variables to be included in the score and their relative weights is obviously vital.…”

Section: /8mentioning

confidence: 99%

To Prognosticate Survival Applying Scoring System based on Clinical Parameters and Study the Morbidity Pattern of Very Low Birth Weight Inborn Preterm Neonates: A Prospective Observational Study from India

Gupta¹,

Chhangani²,

Sharma³

et al. 2015

JPNC

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Objective: To prognosticate survival applying scoring system and study morbidity pattern of very low birth weight (VLBW) preterm neonates admitted in NICU.Methods: Hundred and ten VLBW preterm neonates were included.10 morbid conditions were assessed and graded as per morbidity score given by Minde et al.[1]. Neonates were categorized into 5 groups based on cumulative scores (Group A 0-20, B 21-40, C 41-60, D 61-80, E 81-100). All 5 groups were further divided based on total number of serious conditions (None/ 1 / 2 / 3). Final outcome (Discharged/Expired) was compared in each group.Result: There was statistical increase in hospital duration stay with increase in the severity score. Maximum neonates were in group A (41.8%) followed by group B and C. Mortality increased from group A to E. Most common causes of morbidity was neonatal sepsis. Conclusion:Not only an increasing total cumulative score is associated with poor outcome, rather cumulative score plus the total number of serious conditions predict the outcome more accurately. Keywords:

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“…In the absence of uniformly accepted physiologic or evidence-based RBCT criteria, RBCT practices vary greatly between neonatal intensivecare units [1,[6][7][8][9][10] .…”

Section: Potential Risks and Benefits Of Rbctsmentioning

confidence: 99%

The ‘Effects of Transfusion Thresholds on Neurocognitive Outcome of Extremely Low Birth-Weight Infants (ETTNO)’ Study: Background, Aims, and Study Protocol

Eicher¹,

Seitz²,

Bevot³

et al. 2012

Neonatology

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Background: Infants with extremely low birth weight uniformly develop anemia of prematurity and frequently require red blood cell transfusions (RBCTs). Although RBCT is widely practiced, the indications remain controversial in the absence of conclusive data on the long-term effects of RBCT. Objectives: To summarize the current equipoise and to outline the study protocol of the ‘Effects of Transfusion Thresholds on Neurocognitive Outcome of extremely low birth-weight infants (ETTNO)’ study. Methods: Review of the literature and design of a large pragmatic randomized controlled trial of restrictive versus liberal RBCT guidelines enrolling 920 infants with birth weights of 400–999 g with long-term neurodevelopmental follow-up. Results and Conclusions: The results of ETTNO will provide definite data about the efficacy and safety of restrictive versus liberal RBCT guidelines in very preterm infants.

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Variations in blood transfusions among newborn intensive care units

Cited by 139 publications

References 26 publications

Lead exposure in preterm infants receiving red blood cell transfusions

Lead exposure in preterm infants receiving red blood cell transfusions

To Prognosticate Survival Applying Scoring System based on Clinical Parameters and Study the Morbidity Pattern of Very Low Birth Weight Inborn Preterm Neonates: A Prospective Observational Study from India

The ‘Effects of Transfusion Thresholds on Neurocognitive Outcome of Extremely Low Birth-Weight Infants (ETTNO)’ Study: Background, Aims, and Study Protocol

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