One size will never fit all: the future of research in pediatric transfusion medicine

Josephson, Cassandra D.; Mondoro, Traci Heath; Ambruso, Daniel R.; López-Sánchez, R.; Sloan, Steven R.; Luban, Naomi L.C.; Widness, John A.

doi:10.1038/pr.2014.120

Cited by 19 publications

(14 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Triggers and thresholds for red cell transfusion are accumulating evidence with current phase III clinical trials. Ongoing trials and studies of platelet and plasma transfusions in infants and neonates are anticipated to provide high-quality evidence in years to come 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

Recent advances in transfusions in neonates/infants

Goel

Josephson

2018

F1000Res

Self Cite

View full text Add to dashboard Cite

Transfusions of red blood cells (RBCs), platelets, and plasma are critical therapies for infants and neonates (particularly preterm neonates) in the neonatal intensive care unit, who are the most frequently transfused subpopulation across all ages. Although traditionally a significant gap has existed between the blood utilization and the evidence base essential to adequately guide transfusion practices in infants and neonates, pediatric transfusion medicine is evolving from infancy and gradually coming of age. It is entering an exciting era with recognition as an independent discipline, a new and evolving high-quality evidence base for transfusion practices, novel technologies and therapeutics, and national/international collaborative research, educational, and clinical efforts. Triggers and thresholds for red cell transfusion are accumulating evidence with current phase III clinical trials. Ongoing trials and studies of platelet and plasma transfusions in neonates are anticipated to provide high-quality evidence in years to come. This article aims to summarize the most current evidence-based practices regarding blood component therapy in neonates. Data on the use of specific components (RBCs, plasma, and platelets) are provided. We attempt to define thresholds for anemia, thrombocytopenia, and abnormal coagulation profile in neonates to highlight the difficulties in having a specific cutoff value in neonates and preterm infants. Indications for transfusion of specific products, transfusion thresholds, and current practices and guidelines are provided, and possible adverse outcomes and complications are discussed. Finally, the critical research knowledge gaps in these practices as well as ongoing and future research areas are discussed. In an era of personalized medicine, neonatal transfusion decisions guided by a strong evidence base must be the overarching goal, and this underlies all of the strategic initiatives in pediatric and neonatal transfusion research highlighted in this article.

show abstract

Section: Introductionmentioning

confidence: 99%

Recent advances in transfusions in neonates/infants

Goel

Josephson

2018

F1000Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Limited studies have evaluated the relationship between utilization of donor RBC products and recipient outcomes in neonates—a group that ranks among the most highly transfused patients [4]. With a lifetime ahead for neonates, improving RBC transfusion-related health outcomes, such as safe and effective transfusions themselves, short- and long-term functional health outcomes, and long-term cognitive functioning, is of vital importance.…”

Section: Big Data: Need For Rbc Donor-recipient Linked Cohort Studiesmentioning

confidence: 99%

Research Opportunities to Improve Neonatal Red Blood Cell Transfusion

Patel

Meyer

Widness

2016

Transfusion Medicine Reviews

Self Cite

View full text Add to dashboard Cite

Red blood cell (RBC) transfusion is a common and lifesaving therapy for anemic neonates and infants, particularly among those born prematurely or undergoing surgery. However, evidence-based indications for when to administer RBCs and adverse effects of RBC transfusion on important outcomes including necrotizing enterocolitis, survival and long-term neurodevelopmental impairment remain uncertain. In addition, blood-banking practices for preterm and term neonates and infants have been largely developed using studies from older children and adults. Use of and refinements in emerging technologies and advances in biomarker discovery and neonatal-specific RBC transfusion databases may allow clinicians to better define and tailor RBC transfusion needs and practices to individual neonates. Decreasing the need for RBC transfusion and developing neonatal-specific approaches in the preparation of donor RBCs has potential for reducing resource utilization and cost, improving outcomes, and assuring blood safety. Finally, large donor-recipient linked cohort studies can provide data to better understand the balance of the risks and benefits of RBC transfusion in neonates. These studies may also guide the translation of new research into best practices that can rapidly be integrated into routine care. This review highlights key opportunities in transfusion medicine and neonatology for improving the preparation and transfusion of RBCs into neonates and infants. We focus on timely, currently addressable knowledge gaps that can increase the safety and efficacy of preterm and term neonatal and infant RBC transfusion practices.

show abstract

“…Pediatric transfusion medicine is a developing field with large gaps in evidence-based practice. 42 Whether increased blood transfusion is the cause of increased morbidity or simply a marker of it remains unclear. Neonates and infants are an important subgroup within the pediatric population requiring unique consideration to account for their maturing organ systems, decreased physiologic reserve, and increased surgical blood loss and RBC transfusion requirement (in ml/kg) compared to their larger counterparts.…”

Section: Previous Investigators Found That Increased Transfusion Durimentioning

confidence: 99%

Intraoperative Red Blood Cell Transfusion in Infant Heart Transplant Patients Is Not Associated with Worsened Outcomes

Carter

Lau

Juma

et al. 2016

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

In contrast to a prior report, we found no correlation between intraoperative RBC transfusion and postoperative LOS when studying only infants. Infants have maturing organ systems, less physiologic reserve, and increased surgical blood loss (evaluated as mL/kg) during cardiac surgery than their larger, older counterparts, distinguishing them from the general pediatric population. These differences require additional studies to determine the outcome impact of transfusion strategies in the infant subgroup.

show abstract

One size will never fit all: the future of research in pediatric transfusion medicine

Cited by 19 publications

References 78 publications

Recent advances in transfusions in neonates/infants

Recent advances in transfusions in neonates/infants

Research Opportunities to Improve Neonatal Red Blood Cell Transfusion

Intraoperative Red Blood Cell Transfusion in Infant Heart Transplant Patients Is Not Associated with Worsened Outcomes

Contact Info

Product

Resources

About