Red blood cell transfusions in the newborn

Ramasethu, Jayashree; Luban, Naomi L.C.

doi:10.1016/s1084-2756(99)80003-7

Cited by 42 publications

(34 citation statements)

References 64 publications

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“…Because RBC transfusions carry risks and are expensive, developing specific, quantifiable transfusion 'triggers' remains an important -but thus far elusive -goal [17]. Decision to administer RBC transfusions to anemic preterm infants have been largely based on subjective criteria such as pallor, decreased activity, poor weight gain, poor feeding, tachycardia and apnea [17].…”

Section: Discussionmentioning

confidence: 99%

“…Decision to administer RBC transfusions to anemic preterm infants have been largely based on subjective criteria such as pallor, decreased activity, poor weight gain, poor feeding, tachycardia and apnea [17]. The differences observed in baseline ABR wave latencies between adults and newborn sheep were modest.…”

Section: Discussionmentioning

confidence: 99%

“…Among anemic preterm infants, the decision to administer red blood cell (RBC) transfusions has been based on subjective, ill-defined criteria such as pallor, decreased activity, poor weight gain, poor feeding, tachycardia and apnea [17,18]. Similarly, among anemic adults, objective data regarding when transfusion is required are also lacking [19].…”

Section: Introductionmentioning

confidence: 99%

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Increased Wave Latency in Auditory Brainstem Response to Anemia in Newborn and Adult Sheep

Quiñónez¹,

Widness²

2003

Neonatology

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The objective of the present study was to determine whether phlebotomy-induced anemia in newborn lambs and adult sheep results in prolonged auditory brainstem response (ABR) wave latencies, and if found, whether developmental differences exist between the two groups. Among newborn lambs, hemoglobin (Hb) levels were reduced from 100–120 to 30–50 g/l over a 3-day period. Over the next 2 days, serial red blood cell transfusions were administered to restore Hb to pre-phlebotomy levels. In adult sheep, comparable levels of phlebotomy-induced anemia were achieved within a 24-hour period, after which Hb levels returned to pre-phlebotomy levels. During the induction of anemia and its reversal, a significant (p < 0.05) increase in ABR latency followed by a return to pre-anemia ABR latencies that was most prominent in the peripheral auditory pathway was observed in both newborn and adult sheep as Hb levels fell below 50 g/l (p < 0.05). There was no difference between adults and newborns in ABR latency relative to the Hb level at which ABR wave latencies increased. We speculate that ABR wave latency prolongation might serve as an indicator of the need for red blood cell transfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increased Wave Latency in Auditory Brainstem Response to Anemia in Newborn and Adult Sheep

Quiñónez¹,

Widness²

2003

Neonatology

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“…[62][63][64] Noninvasive drug monitoring can reduce some of these blood draws, volume losses, and associated complications, as well as provide more simple body fluid sampling for the measurement of drug concentrations in the body. Salivary drug concentrations are an excellent noninvasive alternative to plasma drug concentrations, especially in patients with limited intravenous access, provided a good correlation exists between the two.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Treatment of Apnea of Prematurity

Bhatt‐Mehta

Schumacher

2003

Pediatric Drugs

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In the last decade, knowledge regarding the neurodevelopment and functional aspects of the respiratory centers during postnatal maturation has increased substantially. However, an increase in such knowledge has not provided a basis for change in practice. The diagnosis of apnea of prematurity (AOP) is one of exclusion. All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient. The primary goal of any treatment of AOP is to prevent the frequency of apnea lasting >20 seconds, and/or those that are shorter, but associated with cyanosis and bradycardia. The clinical management of AOP is not much different today than it was two decades ago, with pharmacologic and nonpharmacologic treatment options remaining the mainstay of therapy. Methylxanthines are still the most widely used pharmacologic agents. Due to the wider therapeutic index of caffeine and ease of once daily administration, it should be the preferred agent. Doxapram, or nonpharmacologic treatment measures such as nasal continuous positive airway pressure, may be considered in infants who are unresponsive to methylxanthine treatment alone. Treatment should be continued until there is complete resolution of apnea, and for some time thereafter. The choice of method for weaning treatment remains one of individual physician preference. Discharge from hospital after apnea requires close monitoring and some infants will require home apnea monitors. The decision to provide a home apnea monitor should be individualized for each patient, depending on the effectiveness of treatment and clinical response.

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“…The transfusion of blood products to neonates usually is limited to transfusion through peripheral venous catheters (22)(23)(24), whereas central venous catheters (CVCs) are used for infusion of crystalloid solution, medications, and total parenteral nutrition. Because CVCs are difficult to replace and have been associated with thrombotic complications (25)(26)(27)(28), they generally have been deemed unsuitable for blood transfusion.…”

mentioning

confidence: 99%