Strict red blood cell transfusion guideline reduces the need for transfusions in very‐low‐birthweight infants in the first 4 weeks of life: a multicentre trial

Miyashiro, Amélia; Santos, N dos; Guinsburg, Ruth; Kopelman, Benjamin Israel; Peres, C.; Taga, Marcel Frederico de Lima; Shinzato, Alexandre Ryuzo; Costa, Helenilce de Paula Fiod

doi:10.1111/j.1423-0410.2005.00607.x

Cited by 29 publications

(27 citation statements)

References 34 publications

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“…In our ward, RBC transfusion guidelines allow for some physician discretion on site. A decrease in the number of transfusions in successive years can be observed, which is consistent with other publications [2,21]. Further improvement in this field can be achieved by diminishing iatrogenic blood losses using in-line blood gas and chemistry monitors [22].…”

Section: Discussionsupporting

confidence: 77%

Neonatal RBC Transfusions – Comparison of Two Patterns

Podraza

J²,

Domek

et al. 2006

Transfus Med Hemother

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Background: Red blood cell (RBC) transfusions performed over 5 years in a neonatal ward were retrospectively analyzed. Despite the fact that ‘fresh’ RBC smallvolume transfusions given to preterm infants are called ‘traditional’ or even ‘historic’, this method of treatment is still used in all neonatal wards in Poland. Patients and Methods: A total of 846 RBC units were transfused to 216 patients, including 26 term and 190 preterm neonates. The transfusion rate and donor exposure rate were calculated. The same parameters were calculated for hypothetical use of blood satellite packs for transfusions in the analyzed patients and compared with the original data. Results: Application of a limited donor program could diminish the donor exposure rate more than twofold, from 3.5 to 1.63, in the very-low-birth-weight infants group and reduce the maximum number of donors from 11 to 3, at the same transfusion rate of 5.35. Conclusion: Introduction of strict RBC transfusion guidelines and a limited-donor blood program would improve transfusion therapy.

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Section: Discussionsupporting

confidence: 77%

Neonatal RBC Transfusions – Comparison of Two Patterns

Podraza

J²,

Domek

et al. 2006

Transfus Med Hemother

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“…Many recent studies have reported benefits of instituting written transfusion guidelines for NICU patients. [8][9][10][11][12][13] However, much additional study is needed to provide data upon which to base NICU transfusion guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Establishing NICU transfusion guidelines has been advocated as a way to improve transfusion practice and reduce unnecessary transfusions. [8][9][10][11][12][13] In 2002, Intermountain Healthcare, a not-forprofit healthcare organization in the western United States, established a written set of NICU transfusion guidelines. (These guidelines are provided as supplementary material in the electronic version of this article.)…”

Section: Introductionmentioning

confidence: 99%

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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Objective: We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of noncompliance that could be addressed by quality improvement measures. Result: During 2006 the three NICUs cared for 1759 neonates. Seventeen percent of these received one or more (median 3) erythrocyte transfusions, 4% received one or more (median 3) platelet transfusions, 6% received one or more (median 1) FP infusions and 2% received cryoprecipitate (median 1 dose). Seventy percent of the erythrocyte transfusions were given in compliance with the guidelines, as were 69% of the platelet transfusions, 65% of the FP transfusions and 94% of the cryoprecipitate administrations. Patients who received large numbers of transfusions were more likely to receive transfusion that violated the guidelines. Forty-five percent of patients who received 1 to 3 transfusions received all transfusions within guidelines. However, only 18% of patients who received 4 to 10 transfusions received all within guidelines. No patient who received >10 transfusions received all within the guidelines. Erythrocyte transfusions given early in the hospital course were likely to be within guidelines; 72% (588/818) in the first 29 days were compliant with guidelines, but compliance fell to 61% (144/237) for transfusions administered after 29 days (P ¼ 0.002). About half of the platelet transfusions given early in the hospital course were in violation of guidelines, but after day 9, 83% of platelet transfusions were compliant with guidelines (P ¼ 0.000). Conclusion:Opportunities exist in our healthcare system to improve compliance with our transfusion guidelines. Such opportunities are greatest among neonates receiving multiple transfusions, among those receiving erythrocyte transfusions late in their NICU course and among those receiving platelet transfusions early in their NICU course.

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“…Several analyses have shown that the introduction of standardised transfusion guidelines reduces the frequency of transfusions given to preterm babies 22 36 – 39…”

Section: Strategies For Avoiding Transfusionmentioning

confidence: 99%

When to transfuse preterm babies

Bell

2008

Archives of Disease in Childhood - Fetal and Neonatal Edition

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The physiological anaemia experienced by preterm babies is exacerbated by common care practices such as early clamping of the umbilical cord at birth and gradual exsanguination by phlebotomy for laboratory monitoring. The need for subsequent transfusion with red blood cells can be reduced by delaying cord clamping for 30–60 s in infants who do not require immediate resuscitation. The need for transfusions can be further reduced by limiting phlebotomy losses, providing good nutrition, and using standard guidelines for transfusion based on haemoglobin or haematocrit. What those guidelines should be is not clear. Analysis of two recent large clinical trials comparing restrictive and liberal transfusion guidelines leads to several conclusions. Restrictive transfusion guidelines may reduce the number of transfusions given, but there is no reduction in donor exposures if a single-donor transfusion programme is used. There is some evidence that more liberal transfusion guidelines may help to prevent brain injury, but information on the impact of transfusion practice on long-term outcome is lacking. Until further guidance emerges, transfusion thresholds lower than those used in the two trials should not be used, as there is no evidence that lower thresholds are safe.

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Strict red blood cell transfusion guideline reduces the need for transfusions in very‐low‐birthweight infants in the first 4 weeks of life: a multicentre trial

Abstract: The strict guideline was effective in reducing erythrocyte transfusions in very-low-birthweight infants.

Cited by 29 publications

References 34 publications

Neonatal RBC Transfusions – Comparison of Two Patterns

Neonatal RBC Transfusions – Comparison of Two Patterns

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

When to transfuse preterm babies

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