Clinical and research issues in neonatal anemia and thrombocytopenia

Sallmon, Hannes; Sola‐Visner, Martha

doi:10.1097/mop.0b013e32834ee5cc

Cited by 12 publications

(11 citation statements)

References 41 publications

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“…These findings illustrate the critical need for well-designed prospective randomized trials that investigate the outcome of thrombocytopenic neonates and the safety of different platelet transfusion thresholds ( 19 , 25 , 26 ). Furthermore, trials investigating the optimal PDA management (indication for treatment, optimal dosing of NSAIDs, etc.)…”

Section: Discussionmentioning

confidence: 77%

“…Interestingly, male gender, which others and we previously reported to be an independent risk factor for development of an hsPDA, was not significantly associated with treatment failure rates. Similarly, preeclampsia, which is known to affect platelet numbers ( 18 , 19 ), was significantly associated with COXI therapy failure. Interestingly, sepsis/infection had no effect on treatment success rates, which is likely due to the less strict definition used in this study (elevated systemic markers of infection, use of antibiotics).…”

Section: Discussionmentioning

confidence: 99%

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Association between Platelet Counts before and during Pharmacological Therapy for Patent Ductus Arteriosus and Treatment Failure in Preterm Infants

et al. 2018

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BackgroundThe role of platelets for mediating closure of the ductus arteriosus in human preterm infants is controversial. Especially, the effect of low platelet counts on pharmacological treatment failure is still unclear.MethodsIn this retrospective study of 471 preterm infants [<1,500 g birth weight (BW)], who were treated for a patent ductus arteriosus (PDA) with indomethacin or ibuprofen, we investigated whether platelet counts before or during pharmacological treatment had an impact on the successful closure of a hemodynamically significant PDA. The effects of other factors, such as sepsis, preeclampsia, gestational age, BW, and gender, were also evaluated.ResultsPlatelet counts before initiation of pharmacological PDA treatment did not differ between infants with later treatment success or failure. However, we found significant associations between low platelet counts during pharmacological PDA therapy and treatment failure (p < 0.05). Receiver operating characteristic (ROC) curve analysis showed that platelet counts after the first, and before and after the second cyclooxygenase inhibitor (COXI) cycle were significantly associated with treatment failure (area under the curve of >0.6). However, ROC curve analysis did not reveal a specific platelet cutoff-value that could predict PDA treatment failure. Multivariate logistic regression analysis showed that lower platelet counts, a lower BW, and preeclampsia were independently associated with COXI treatment failure.ConclusionWe provide further evidence for an association between low platelet counts during pharmacological therapy for symptomatic PDA and treatment failure, while platelet counts before initiation of therapy did not affect treatment outcome.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Association between Platelet Counts before and during Pharmacological Therapy for Patent Ductus Arteriosus and Treatment Failure in Preterm Infants

et al. 2018

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“…The underlying mechanism of the relationship between anemia and BPD may be explained as follows 15 16 17 18 . First, anemia may result in decreased oxygen carrying capacity of blood to lungs, resulting in increased anaerobic metabolism and high levels of lactic acid production.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis is usually multifactorial; it can result from inadequate erythropoietin response, rapid growth, and repeated blood sampling for laboratory tests 15 16 . Symptoms of anemia include lactic acidosis, tachycardia, bradycardia, tachypnea, apnea, poor weight gain, diminished activity, and oxygen requirement 17 18 . Nevertheless, the effect of anemia on BPD has not yet been investigated yet.…”

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confidence: 99%

Association between anemia and bronchopulmonary dysplasia in preterm infants

Duan

Kong

et al. 2016

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Anemia is commonly seen in preterm infants. It may reduce the capacity of hemoglobin to transport oxygen throughout the body and may result in tissue and organ dysfunction. This study aimed to investigate the effect of anemia on the development of bronchopulmonary dysplasia (BPD) in preterm infants. 243 infants who were admitted to BaYi Children’s Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital with gestational age (GA) less than 32 weeks from February, 2014 to February, 2015 were included in the study. Maternal and infant data were recorded. Multivarariate logistic regression analysis was performed to determine the association between anemia and BPD. Of 243 preterm infants, the incidence of anemia was higher in BPD patients than non-BPD patients (p < 0.001). Mean Hct in BPD patients was lower than non-BPD patients at different time points in 1d, 7d, 14d, and 21d. Controlling for other confounding factors, early anemia was associated with an increased risk of BPD. Number of transfusions is also a significant risk factor for BPD (p = 0.001). Therefore, prevention and treatment of early anemia is necessary and reducing number of transfusions may reduce the incidence of BPD in preterm infants.

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“…In current neonatology practice, when a transfusion is contemplated, the neonatologist will generally contextualize the best treatment by integrating his/her own past clinical experiences with information recently acquired from reliable sources [2,3,4,5,6,7]. However, progress toward better outcomes and cost containment requires that this process be replaced by a new paradigm of evidence-based decision making [1].…”

Section: An Evidence Base To Inform and Continually Improve Transfusimentioning

confidence: 99%

Evidence-Based Advances in Transfusion Practice in Neonatal Intensive Care Units

2014

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Background: Transfusions to neonates convey both benefits and risks, and evidence is needed to guide wise use. Such evidence is accumulating, but more information is needed to generate sound evidence-based practices. Objective: We sought to analyze published information on nine aspects of transfusion practice in neonatal intensive care units. Methods: We assigned ‘categories of evidence' and ‘recommendations' using the format of the United States Preventive Services Task Force of the Agency for Healthcare Research and Quality. Results: The nine practices studied were: (1) delayed clamping or milking of the umbilical cord at preterm delivery - recommended, high/substantial A; (2) drawing the initial blood tests from cord/placental blood from very low birth weight (VLBW, <1,500 g) infants at delivery - recommended, moderate/moderate B; (3) limiting phlebotomy losses of VLBW infants - recommended, moderate/substantial B; (4) selected use of erythropoiesis-stimulating agents to prevent transfusions - recommended, moderate/moderate-moderate/small B, C; (5) using platelet mass, rather than platelet count, in platelet transfusion decisions - recommended, moderate/small C; (6) permitting the platelet count to fall to <20,000/µl in ‘stable' neonates before transfusing platelets - recommended, low/small I; (8) permitting the platelet count to fall to <50,000/µl in ‘unstable' neonates before transfusing platelets - recommended, moderate/small C, and (9) not performing routine coagulation test screening on every VLBW infant - recommended, moderate/small C. Conclusions: We view these recommendations as dynamic, to be revised as additional evidence becomes available. We predict this list will expand as new studies provide more information to guide best transfusion practices.

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Clinical and research issues in neonatal anemia and thrombocytopenia

Cited by 12 publications

References 41 publications

Association between Platelet Counts before and during Pharmacological Therapy for Patent Ductus Arteriosus and Treatment Failure in Preterm Infants

Association between Platelet Counts before and during Pharmacological Therapy for Patent Ductus Arteriosus and Treatment Failure in Preterm Infants

Association between anemia and bronchopulmonary dysplasia in preterm infants

Evidence-Based Advances in Transfusion Practice in Neonatal Intensive Care Units

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