When to transfuse preterm babies

Bell, Edward F.

doi:10.1136/adc.2007.128819

Cited by 39 publications

(23 citation statements)

References 57 publications

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“…The method could be of relevant use in older ex-preterm infants where we currently check the hemoglobin values once a week to make sure they do not become too anemic. We find it unlikely that using Mediscan would lead to an increased use of transfusions as the decision to transfuse is based on a wider set of clinical criteria [13] . Ideally, one would like to have a noninvasive method to measure hematocrit as well.…”

Section: Discussionmentioning

confidence: 99%

Spectroscopic Noninvasive Measurement of Hemoglobin Compared with Capillary and Venous Values in Neonates

Rabe¹,

Álvarez²,

Whitfield

et al. 2009

Neonatology

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Background: Venepuncture-related blood loss is a common cause of neonatal anemia. Currently, this is the only way to obtain hemoglobin levels. This causes distress for the infant but can also lead to the need for blood transfusions. Recently, a new technique for measuring hemoglobin levels non-invasively has been developed to reduce iatrogenic blood loss and pain. Objective: To compare hemoglobin levels obtained using a transcutaneous spectroscopic device (Mediscan 2000, MBR Optical Systems, Wuppertal, Germany) with venous or capillary blood samples in neonates. Methods: Single-center prospective cohort study of term and preterm infants. The white light spectroscopic device was placed on the forearm for 60 s to measure hemoglobin content within 4 h of venous or capillary blood sampling. Pain reactions of the infants were assessed by using a neonatal pain assessment tool. Results were analyzed by Bland-Altman comparison and Wilcoxon signed-rank test. Results: 80 infants (mean gestational age 29.8 ± 3.8 weeks, mean birth weight 1,300 ± 690 g) were enrolled into the study. A total of 313 spectroscopic recordings within 2 h of a clinically indicated blood sample (181 capillary, 142 venous) were taken. The correlation coefficient R² was 0.96 for capillary/spectroscopic and 0.99 for venous/spectroscopic pairs. Pain scores were significantly less for the spectroscopic measurements (p < 0.01). Conclusion: The results show good correlation between the hemoglobin blood levels and spectroscopic measurements. The slightly lower correlation coefficient for the capillary samples demonstrates a naturally higher variance in these values due to the laboratory method.

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Section: Discussionmentioning

confidence: 99%

Spectroscopic Noninvasive Measurement of Hemoglobin Compared with Capillary and Venous Values in Neonates

Rabe¹,

Álvarez²,

Whitfield

et al. 2009

Neonatology

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“…According to several studies, diagnostic testing is the main reason of blood loss during ICU stay in all age groups [5][6][7]. The presence of arterial lines or central venous catheters contributes to a 2.3-to 4-fold higher median number of blood samplings per day [8].…”

Section: Prevention Of Iatrogenic Anemia In Pediatric Carementioning

confidence: 99%

Prevention of Iatrogenic Anemia in Critical and Neonatal Care

Jakacka¹,

Snarski²,

Mekuria³

2015

Adv Clin Exp Med

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Iatrogenic anemia caused by diagnostic blood sampling is a common problem in the intensive care unit, where continuous monitoring of blood parameters is very often required. Cumulative blood loss associated with phlebotomy along with other factors render this group of patients particularly susceptible to anemia. As it has been proven that anemia in this group of patients leads to inferior outcomes, packed red blood cell transfusions are used to alleviate possible threats associated with low hemoglobin concentration. However, the use of blood components is a procedure conferring a set of risks to the patients despite improvements in safety. Iatrogenic blood loss has also gained particular attention in neonatal care, where cumulative blood loss due to samples taken during the first week of life could easily equal or exceed circulating blood volume. This review summarizes the current knowledge on the causes of iatrogenic anemia and discusses the most common preventive measures taken to reduce diagnostic blood loss and the requirement for blood component transfusions in the aforementioned clinical situations (Adv Clin Exp Med 2016, 25, 1, 191-197).

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“…These large numbers rank small preterm infants as the most heavily transfused population of any hospitalised patient group. Several trials have examined the criteria used to guide transfusions and their impact on outcome,3–5 yet clear guidance on the indications for transfusions remains elusive 6 7. Little is known about the adaptive responses to anaemia in VLBW infants and the effects of transfusion at various levels of anaemia on the delivery and utilisation of oxygen 8–11.…”

Section: Introductionmentioning

confidence: 99%

Acute physiological effects of packed red blood cell transfusion in preterm infants with different degrees of anaemia

Fredrickson

Bell

Cress

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objective The safe lower limit of hematocrit or hemoglobin that should trigger a red blood cell (RBC) transfusion has not been defined. The objective of this study was to examine the physiological effects of anemia and compare the acute responses to transfusion in preterm infants who were transfused at higher or lower hematocrit thresholds. Methods We studied 41 preterm infants with birth weights 500-1300 g, who were enrolled in a clinical trial comparing high (“liberal”) and low (“restrictive”) hematocrit thresholds for transfusion. Measurements were performed before and after a packed RBC transfusion of 15 ml/kg, which was administered because the infant's hematocrit had fallen below the threshold defined by study protocol. Hemoglobin, hematocrit, red blood cell count, reticulocyte count, lactic acid, and erythropoietin were measured before and after transfusion using standard methods. Cardiac output was measured by echocardiography. Oxygen consumption was determined using indirect calorimetry. Systemic oxygen transport and fractional oxygen extraction were calculated. Results Systemic oxygen transport rose in both groups following transfusion. Lactic acid was lower after transfusion in both groups. Oxygen consumption did not change significantly in either group. Cardiac output and fractional oxygen extraction fell after transfusion in the low hematocrit group only. Conclusions Our results demonstrate no acute physiological benefit of transfusion in the high hematocrit group. The fall in cardiac output with transfusion in the low hematocrit group shows that these infants had increased their cardiac output to maintain adequate tissue oxygen delivery in response to anemia and, therefore, may have benefitted from transfusion.

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When to transfuse preterm babies

Cited by 39 publications

References 57 publications

Spectroscopic Noninvasive Measurement of Hemoglobin Compared with Capillary and Venous Values in Neonates

Spectroscopic Noninvasive Measurement of Hemoglobin Compared with Capillary and Venous Values in Neonates

Prevention of Iatrogenic Anemia in Critical and Neonatal Care

Acute physiological effects of packed red blood cell transfusion in preterm infants with different degrees of anaemia

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