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Red Blood Cell Transfusion in European Neonatal Intensive Care Units, 2022 to 2023
NAM. Houben, S. Fustolo-Gunnink, K. Fijnvandraat, C. Caram-Deelder, MA. Carrascosa, A. Beuchée, K. Brække, F. Cardona, A. Debeer, S. Domingues, S. Ghirardello, R. Grizelj, E. Hadžimuratovic, C. Heiring, JL. Krivec, J. Malý, K. Matasova, CM....
Language English Country United States
Document type Journal Article, Observational Study, Multicenter Study
NLK
Directory of Open Access Journals
from 2018
ProQuest Central
from 2018-01-01
Health & Medicine (ProQuest)
from 2018-01-01
- MeSH
- Intensive Care Units, Neonatal * statistics & numerical data MeSH
- Humans MeSH
- Infant, Premature MeSH
- Infant, Newborn MeSH
- Prospective Studies MeSH
- Erythrocyte Transfusion * statistics & numerical data methods MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- Europe MeSH
IMPORTANCE: Red blood cell (RBC) transfusions are frequently administered to preterm infants born before 32 weeks of gestation in the neonatal intensive care unit (NICU). Two randomized clinical trials (Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants [ETTNO] and Transfusion of Prematures [TOP]) found that liberal RBC transfusion thresholds are nonsuperior to restrictive thresholds, but the extent to which these results have been integrated into clinical practice since publication in 2020 is unknown. OBJECTIVE: To describe neonatal RBC transfusion practice in Europe. DESIGN, SETTING, AND PARTICIPANTS: This international prospective observational cohort study collected data between September 1, 2022, and August 31, 2023, with a 6-week observation period per center, from 64 NICUs in 22 European countries. Participants included 1143 preterm infants born before 32 weeks of gestation. EXPOSURE: Admission to the NICU. MAIN OUTCOMES AND MEASURES: Study outcome measures included RBC transfusion prevalence rates, cumulative incidence, indications, pretransfusion hemoglobin (Hb) levels, volumes, and transfusion rates, Hb increment, and adverse effects of RBC transfusion. RESULTS: A total of 1143 preterm infants were included (641 male [56.1%]; median gestational age at birth, 28 weeks plus 2 days [IQR, 26 weeks plus 2 days to 30 weeks plus 2 days]; median birth weight, 1030 [IQR, 780-1350] g), of whom 396 received 1 or more RBC transfusions, totaling 903 transfusions. Overall RBC transfusion prevalence rate during postnatal days 1 to 28 was 3.4 transfusion days per 100 admission days, with considerable variation across countries, only partly explained by patient mix. By day 28, 36.5% (95% CI, 31.6%-41.5%) of infants had received at least 1 transfusion. Most transfusions were given based on a defined Hb threshold (748 [82.8%]). Hemoglobin levels before transfusions indicated for threshold were below the restrictive thresholds set by ETTNO in 324 of 729 transfusions (44.4%) and TOP in 265 of 729 (36.4%). Conversely, they were between restrictive and liberal thresholds in 352 (48.3%) and 409 (56.1%) transfusions, respectively, and above liberal thresholds in 53 (7.3%) and 55 (7.5%) transfusions, respectively. Most transfusions given based on threshold had volumes of 15 mL/kg (470 of 738 [63.7%]) and were administered over 3 hours (400 of 738 [54.2%]), but there was substantial variation in dose and duration. CONCLUSIONS AND RELEVANCE: In this cohort study of very preterm infants, most transfusions indicated for threshold were given for pretransfusion Hb levels above restrictive transfusion thresholds evaluated in recent trials. These results underline the need to optimize practices and for implementation research to support uptake of evidence.
2 Department of Neonatology Poznan University of Medical Sciences Poznan Poland
Centro Materno Infantil do Norte Unidade Local de Saúde de Santo António Porto Portugal
Charité Universitätsmedizin Berlin Berlin Germany
Department of Clinical Epidemiology Leiden University Medical Center Leiden the Netherlands
Department of Neonatology Karolinska Institute Stockholm Sweden
Department of Neonatology La Fe University Hospital Valencia Spain
Department of Neonatology Semmelweis University Budapest Hungary
Department of Neonatology Universitair Ziekenhuis Leuven Leuven Belgium
Department of Neonatology University Hospital Zurich Zurich Switzerland
Department of Pediatrics Centre Hospitalier Universitaire de Rennes Rennes France
Department of Pediatrics University Hospital Hradec Králové Hradec Králové Czech Republic
Division of Neonatology Medical University Vienna Vienna Austria
Faculty of Health Sciences University of Bristol Bristol United Kingdom
Faculty of Medicine University of Ljubljana Ljubljana Slovenia
Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Pavia Italy
Jessenius Faculty of Medicine University Hospital Martin Martin Slovakia
National Maternity Hospital Dublin Ireland
NHS Blood and Transplant London United Kingdom
Paediatric Clinic University Medical Center Sarajevo Sarajevo Bosnia and Herzegovina
Radcliffe Department of Medicine University of Oxford Oxford United Kingdom
Sanquin Research Department of Molecular Cellular Hemostasis Amsterdam the Netherlands
Sanquin Research Sanquin Blood Supply Foundation Amsterdam the Netherlands
School of Medicine University College Dublin Dublin Ireland
University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca Romania
Women's and Children's Division Southmead Hospital North Bristol NHS Trust Bristol United Kingdom
References provided by Crossref.org
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