Postponing or eliminating red blood cell transfusions of very low birth weight neonates by obtaining all baseline laboratory blood tests from otherwise discarded fetal blood in the placenta

Christensen, Robert D.; Lambert, D K; Baer, Vickie L.; Montgomery, Dianne; Barney, Cindy K.; Coulter, David M.; Ilstrup, Sarah J.; Bennett, Sterling T.

doi:10.1111/j.1537-2995.2010.02827.x

Cited by 45 publications

(41 citation statements)

References 21 publications

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“…In paired samples, complete blood count and manual differential count are clinically equivalent [18,19]. Blood culture results from umbilical cord segments or fetal vessels on the placenta have been investigated in several studies [17,18,19,20,21,22,23]. This method offers the benefit of increased blood culture volume, thereby increasing the sensitivity of the blood culture [24,25].…”

Section: Rbc Transfusionmentioning

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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Section: Rbc Transfusionmentioning

confidence: 99%

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

2014

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“…However, it is term infants with chorioamnionitis and preterm infants, particularly very-low-birth-weight (VLBW) preterm infants, who stand to gain most by having their initial NICU laboratory tests drawn from otherwise-discarded fetal blood. In this way, a large initial phlebotomy of the VLBW infant is avoided [2, 3, 5]. The reason we performed this study with term samples is the relative ease and homogeneity, but we realize that the conclusions drawn from this study might not apply precisely to preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Otherwise-Discarded Umbilical Cord Blood as a Source for a Neonate’s Complete Blood Cell Count at Various Time Points

et al. 2018

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Background: Previous studies have reported the use of cord blood for admission laboratory complete blood counts (CBCs). However, no studies have investigated its stability for the first 30 min after delivery. Objectives: We quantified blood cells drawn from the umbilical vein to determine the effect of (1) the time after placental delivery, and (2) the site of blood sampling (umbilical vein on an isolated cord segment vs. umbilical vein on the placental surface). Methods: Timed phlebotomies were drawn at 2, 10, and 30 min from (1) the umbilical vein on an isolated, double-clamped cord segment, and (2) the umbilical vein near or on the placental surface. Leukocyte count, hemoglobin, platelet count, and fibrinogen were measured on each phlebotomy sample. Results: Blood drawn from the isolated umbilical cord segments had leukocyte count, hemoglobin, platelet count, and fibrinogen that remained unchanged between the phlebotomies at 2, 10, and 30 min after delivery. However, blood drawn from the umbilical vein on the placental surface had, at 30 min, a leukocyte count (p = 0.002), hemoglobin (p = 0.01), and platelet count (p = 0.001) that were statistically different from the values at 2 and 10 min after delivery. There was no difference in fibrinogen at 2, 10, or 30 min. Conclusions: If cord blood is used for a neonate’s initial CBC, the blood should be drawn within 10 min of the placental delivery when it is taken from the umbilical vein on or near the placenta. If an umbilical cord segment is obtained, the phlebotomy can be delayed for up to 30 min.

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“…42 (14) 30 (10) 52 (17) .239 Native American, % (n) 64 (21) 33 (11) 39 (13) .039 SGA, % (n) 21 (7) 18 (6) 12 (4) .368 Singleton % (n)…”

Section: Resultsmentioning

confidence: 99%

“…21 In addition, with new evidence from recent studies that demonstrate potential side effects of red cell transfusions, such as extension of ICH and transfusionassociated NEC, [11][12][13]22 the need to study the safety and efficacy of ESAs, in combination with restrictive transfusion guidelines, urgently increases. This is the first prospective, randomized, masked, multicenter study of early Darbe administered to preterm infants, and the first study of ESA administration to preterm infants that resulted in a significant decrease in both donor exposure and transfusion number.…”

Section: Figurementioning

confidence: 99%

“…However, long-term neurodevelopmental outcomes among those randomized to be liberally transfused were considerably worse. 9,10 Recent studies suggest an association between preterm infant morbidities, such as necrotizing enterocolitis (NEC) and significant intracranial hemorrhage (ICH), with transfusions [11][12][13] ; therefore, using ESAs to avoid these possible risks might prove clinically important.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

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A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

2013

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Postponing or eliminating red blood cell transfusions of very low birth weight neonates by obtaining all baseline laboratory blood tests from otherwise discarded fetal blood in the placenta

Abstract: We speculate that this method is feasible and generally postpones the first RBC transfusion until beyond the period of peak vulnerability to IVH.

Cited by 45 publications

References 21 publications

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

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

Evaluating Otherwise-Discarded Umbilical Cord Blood as a Source for a Neonate’s Complete Blood Cell Count at Various Time Points

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

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