Fresh Frozen Plasma Transfusion: An Independent Risk Factor for Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

Huang, Chih-Fang; Hung, Yi-Li; Hsieh, Wu‐Shiun; Shen, Chung-Min

doi:10.1055/s-0040-1722649

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…The improvement of diuresis observed in the postintervention, although in the normal range in both study periods, further supports the concept that FFP transfusion may worsen cardiac and respiratory performances, namely TACO and TRALI [20,24]. Indeed, FFP use has been identified as an independent risk factor for hemodynamically significant patent ductus arteriosus in preterm neonates due to a fluid management perturbation [25].…”

Section: Discussion/conclusionsupporting

confidence: 71%

Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study

et al. 2022

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Fresh frozen plasma (FFP) is largely misused in the neonatal setting. The aim of the study is to evaluate the impact of a Thromboelastography (TEG)-based Quality Improvement (QI) project on perioperative FFP use and neonatal outcomes. Retrospective pre-post implementation study in a level-III NICU including all neonates undergoing major non-cardiac surgery before (01–12/2017) and after (01–12/2019) the intervention. In 2018, the intervention included the following: (1) Training on TEG, (2) Implementation of TEG, and (3) Algorithm for TEG-directed FFP administration in surgical neonates. We compared pre- vs post-intervention patient characteristics, hemostasis, and clinical management. Linear and logistic regression models were used to evaluate the impact of the project on main outcomes. We analyzed 139 neonates (pre-intervention: 72/post-intervention: 67) with a mean (± SD) gestational age (GA) 34.9 (± 5) weeks and birthweight 2265 (± 980) grams which were exposed to 184 surgical procedures (pre-intervention: 91/post-intervention: 93). Baseline characteristics were similar between periods. In 2019, prothrombin time (PT) was longer (14.3 vs 13.2 s; p < 0.05) and fibrinogen was lower (229 vs 265 mg/dl; p < 0.05), if compared to 2017. In 2019, the intraoperative exposure to FFP decreased (31% vs 60%, p < 0.001), while the pre-operative FFP use did not change. The reduction of intraoperative FFP did not impact on mortality and morbidity. Intraoperative FFP use was lower in the post-intervention even after controlling for GA, American Society of Anesthesiologists score, PT, and fibrinogen (Odds ratio: 0.167; 95% CI: 0.070, 0.371). Conclusion: The TEG-based QI project for the management of FFP during neonatal surgery reduced intraoperative FFP exposure. What is Known:• PT and aPTT are poor predictors of bleeding risk in acquired neonatal coagulopathy, leading to likely unnecessary fresh frozen plasma (FFP) transfusion in the Neonatal Intensive Care Setting. • As neonatal hemostasis is a delicate balance between the concomitant reduction of pro- and anti-coagulants drivers, thromboelastography (TEG) is a promising alternative for coagulation monitoring. What is New:• The implementation of TEG, training, and shared protocols contributed to reduced intraoperative FFP use, which was not associated with increased mortality or bleeding events.• These findings inform future research showing that there is clinical equipoise to allow for larger studies to confirm the use of TEG in NICUs and to identify TEG cut-offs for transfusion practice.

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Section: Discussion/conclusionsupporting

confidence: 71%

Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study

et al. 2022

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“…However, De Buyst et al [34] concluded that fluid restriction did not reduce pulmonary circulation overload in their prospective observational study. Additionally, this association is also postulated to be triggered by an increase in prostaglandin E2 levels resulting from excessive fluid intake [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Association between Fluid Balance and Treatment Outcome of Ibuprofen for Patent Ductus Arteriosus in Preterm Infants

Liu¹,

Yuan²

2023

Rev. Cardiovasc. Med.

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Background: Excessive fluid intake is a predictor of the development of patent ductus arteriosus (PDA) in preterm infants. Previous studies have examined the relationship between fluid intake and outcomes following ibuprofen for PDA. However, there is a lack of data to determine whether fluid balance has an effect on ibuprofen treatment for PDA. Therefore, this study sought to determine the relationship between fluid balance and outcomes following treatment with ibuprofen for PDA. Methods: We conducted a retrospective study of 110 infants admitted to the Children's Hospital of Chongqing Medical University between January 2017 and April 2022, who were treated with ibuprofen for hemodynamically significant PDA (hsPDA). We calculated the average fluid balance before and during the two courses of ibuprofen treatment and whether they were significantly associated with outcomes in hsPDA patients. Results: In the first course of ibuprofen treatment (FIT), responders had lower fluid balance before FIT compared to non-responders [median 31.82 (18.01, 39.66) vs 34.68 (25.31, 43.56) mL/kg/day; p = 0.049], while the fluid balance during FIT [median 40.61 (33.18, 63.06) vs 42.65 (30.02, 57.96) mL/kg/day; p = 0.703] did not differ between responders and non-responders. Fluid balance before the second course of ibuprofen treatment (SIT) (mean 41.58 ± 14.26 vs 35.74 ± 10.99 mL/kg/day; p = 0.322) and during SIT (mean 39.21 ± 12.65 vs 37.00 ± 21.38 mL/kg/day; p = 0.813) was not found to have a significant association with SIT outcome. Multivariate logistic regression analysis showed fluid balance before FIT was a predictor for FIT success [Odds ratio (OR): 0.967; 95% confidence interval (CI): 0.935-0.999; p = 0.042]. Fluid balance within the first week of life had a greater association with the FIT outcome (OR: 0.967, 95% CI: 0.939-0.996, p = 0.027). Gestational diabetes mellitus and higher Apgar scores decreased the possibility of PDA closure after FIT. Conclusions: Lower fluid balance before FIT, especially within the first week of life appeared to be a predictor for closure of hsPDA after FIT in preterm infants.

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Risk stratification of hemodynamically significant patent ductus arteriosus by clinical and genetic factors

et al. 2023

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Fresh Frozen Plasma Transfusion: An Independent Risk Factor for Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

Cited by 3 publications

References 40 publications

Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study

Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study

Association between Fluid Balance and Treatment Outcome of Ibuprofen for Patent Ductus Arteriosus in Preterm Infants

Risk stratification of hemodynamically significant patent ductus arteriosus by clinical and genetic factors

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