Platelet Transfusion for PDA Closure in Preterm Infants: A Randomized Controlled Trial

Abstract

BACKGROUND AND OBJECTIVES: Thrombocytopenia is associated with late closure of patent ductus arteriosus (PDA). There are few studies evaluating platelet transfusions to treat PDA. We compared liberal platelet-transfusion criteria (to maintain a platelet count >100 000 per µL) versus standard criteria achieve earlier PDA closure among thrombocytopenic preterm neonates (<35 weeks’ gestation) with hemodynamically significant PDA (hs-PDA) presenting within the first 2 weeks of life. METHODS: Thrombocytopenic (<100 000 per µL) preterm neonates with hs-PDA were enrolled and randomly allocated to the liberal and standard transfusion groups: 22 in each arm. They underwent echocardiography daily until closure of PDA, completion of 120 hours follow-up, or death. All subjects received standard cotreatment with nonsteroidal antiinflammatory drugs. Primary outcome of time to PDA closure was compared by survival analysis. Multivariate Cox proportional hazard regression was performed with randomization group, baseline platelet count, gestational age, and age at enrollment as predictor variables. RESULTS: Median time to PDA closure was 72 (95% confidence interval [CI] 55.9–88.1) versus 72 (95% CI 45.5–98.4) hours in the liberal versus restrictive transfusion groups, respectively (unadjusted hazard ratio 0.88 [95% CI 0.4–1.9]; P = .697). Despite adjusting for potential confounders, there was no significant difference in time to PDA closure. In the liberal transfusion group, 40.9% of infants had any grade of intraventricular hemorrhage compared with 9.1% in the restrictive group (P = .034). CONCLUSIONS: Attempting to maintain a platelet count >100 000 per µL by liberally transfusing platelets in preterm thrombocytopenic neonates with hs-PDA does not hasten PDA closure.

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

“…Blood pressure was measured on the third day after birth, after 72 hours when the PDA was closed; it was found that the blood pressure of premature newborns with peripheral arterial ischemia was significantly more likely to be in the 50th percentile or lower. This result confirmed that low blood pressure can cause vasospasms and thrombosis, and consequently peripheral arterial ischemia and skin necrosis [25]. Premature newborns commonly experience low blood pressure due to treatment of their conditions and surgery, and very premature newborns commonly experience shock in the early neonatal period.…”

The current state of the platelet supply in the US and proposed options to decrease the risk of critical shortages

“…Recent randomized trials 40–42 have provided evidence that, in some settings, platelet transfusions cause harm rather than provide benefit. Not administering platelet transfusions in these settings would preserve platelet inventories for transfusion indications where benefits are more clearly established.…”

The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

“…Similarly, thrombocytopenia on the first day of life was associated with delayed ductal closure and the risk of hsPDA on day 7 of life [21]. In this context, transfusions to maintain platelets counts at >100,000/µL did not improve the rate of or hasten PDA closure [22] and were also associated with an increased risk of IVH [22]. Moreover, lowering the transfusion threshold from 50,000 to 25,000 platelets/µL was found to reduce the rates of death and major bleeding in preterm newborns [23].…”