Why do four NICUs using identical RBC transfusion guidelines have different gestational age-adjusted RBC transfusion rates?

Abstract

Using transfusion guidelines has been shown previously to reduce practice variability, lower transfusion rates and diminish transfusion costs. Based on our present findings, we maintain that even when transfusion guidelines are in place and adhered to rigorously, RBC transfusion rates are reduced further if anemia-preventing strategies are also in place.

Erythropoiesis Stimulating Agents Demonstrate Safety and Show Promise as Neuroprotective Agents in Neonates

“…18,19 In addition, there is mounting evidence—bolstered by recent studies including this study by Fauchere et al—indicating that early Epo administration to preterm neonates does not increase their risk for developing ROP or any other complications of prematurity. We eagerly await the long-term follow-up results of this and other studies such as the Preterm Erythropoietin for Neuroprotection (PE-NUT) study to determine whether high dose ESAs are also neuroprotective.…”

Darbepoetin Administration in Term and Preterm Neonates

“…Preterm infants have received fewer transfusions over the last several years compared to previous decades (20). This has been in part due to an increased awareness of morbidities, including transfusion-related lung injury, donor exposure, and transfusion-related intestinal injury (21).…”

“…This has been in part due to an increased awareness of morbidities, including transfusion-related lung injury, donor exposure, and transfusion-related intestinal injury (21). The development and adherence to transfusion guidelines, cord milking/delayed cord clamping, and reduction in phlebotomy losses have all contributed to an overall decrease in transfusions (20). Some studies have demonstrated that the more liberal use of blood transfusions may not improve outcomes (2).…”

“…Such guidelines included initiating iron and Darbe treatment, instituting delayed cord clamping/cord milking, and introducing policies for limiting phlebotomy losses. The study found that the NICUs that adhered to such anemia preventing guidelines also had lower rates of neonatal morbidities, such as necrotizing enterocolitis (≥ Bell stage 2), retinopathy of prematurity (ROP) (≥ stage 3), or severe intraventricular hemorrhage (≥ grade 3) (20). The results of trials in which preterm infants received Darbe as an anemia preventing technique are reviewed below.…”

Anemia of Prematurity and Oral Feeding Milestones in Premature Infants

“…[12][13][14] In contemporary NICUs, with restrictive transfusion guidelines, there is a trend for tolerating lower HCT levels in premature infants as reflected from the reports of decreased transfusion rates over time. 15 The impact of tolerating such lower HCT thresholds on oral feeding outcomes in premature infants is not well described. The objective of the current study was to determine whether the HCT level at initial per oral (PO) feeding is associated with the duration to reach full PO feeding milestone in premature infants, and whether anemia if at all impacts the aerodigestive, feeding milestones and discharge outcomes.…”