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Reference Library HomeA Very Strict Guideline Reduces the Number of Erythrocyte Transfusion in Preterm Infants
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Date Posted: Tuesday, November 18th, 2008
| Vox Sang. 2008 Aug;95(2):106-111. Epub 2008 Jun 9 Mimica AF, dos Santos AM, da Cunha DH, Guinsburg R, Bordin JO, Chiba A, Barros MM, Kopelman BI |
| Abstract Here |
| Summary |
| Among patients of all ages, preterm infants receive the most blood transfusions. Although strict guidelines are used to reduce the risks associated with allogenic RBC transfusions, the hemoglobin level to maintain cellular metabolism in these infants is not known and balancing the risks and benefits of restrictive guidelines for transfusions is challenging. In this prospective study, Mimica and associates assessed whether a very strict guideline would reduce RBC transfusions in preterm infants without adverse outcomes. Neonates born at <37 wk gestation with birth weights <1500 g were studied. Those born in period 1 were given transfusions based on a strict guideline and those in period 2 according to a very strict guideline. Guidelines were based on hematocrits, mean airway pressures, cardiac heart failure, need for mechanical ventilation, oxygen fraction inspired, vasopressor use, weight gain, and whether major or minor surgery was required. Packed RBCs were similarly prepared during both study periods. Demographic and clinical data were obtained from the mothers and infants. During periods 1 and 2, 69 of 108 and 78 of 108 admitted infants, respectively, met study criteria. Demographic and clinical characteristics of the infants were similar in both periods, except for the frequency of respiratory distress syndrome, sepsis, and retinopathy of prematurity, which were less frequent in the second period. Compared to period 1, the number of transfusions was lower in period 2 during the first 28 d of life (3.4 ± 3.8 vs. 1.7 ± 2.2), from 28 d to discharge (1.5 ± 2.6 vs. 0.7 ± 1.0), and during the entire hospitalization (3.4 ± 3.8 vs. 1.7 ± 2.2). The median hematocrit value before transfusion was lower in period 2 but was similar in both periods at 28 d of life. Neonates receiving transfusions had lower birth weights, lower gestational age, lower hematocrit during the first 18 d of life, longer need for mechanical ventilation, greater blood loss for laboratory tests, longer hospital stay, and higher incidences of periventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity. The stricter guideline was significantly associated with a reduction in the number of RBC transfusions received by neonates by 0.55 U/patient. The adoption of the very strict guideline reduced the median number of RBC transfusions by one transfusion and the median number of donor exposures per infant transfused from two to one. The infant’s clinical course was not threatened by the very strict guideline during the hospital stay. However, more studies are required to evaluate long-term clinical outcomes in neonates who receive transfusions according to these very strict guidelines. |