Platelet Transfusion Practices Among Very-Low-Birth-Weight Infants

Overview

Journal JAMA Pediatr

Publisher American Medical Association

Date 2016 May 24

PMID 27213618

Citations 29

Authors

Katherine A Sparger

Susan F Assmann

Suzanne Granger

Abigail Winston

Robert D Christensen

John A Widness

Cassandra Josephson

Sean R Stowell

Matthew Saxonhouse

Martha Sola-Visner

Affiliations

Soon will be listed here.

Abstract

Importance: Thrombocytopenia and intraventricular hemorrhage (IVH) are common among very-low-birth-weight (VLBW) infants. Survey results suggest that US neonatologists frequently administer platelet transfusions to VLBW infants with mild to moderate thrombocytopenia.

Objectives: To characterize platelet transfusion practices in US neonatal intensive care units (NICUs), to determine whether severity of illness influences platelet transfusion decisions, and to examine the association between platelet count (PCT) and the risk for IVH in the first 7 days of life.

Design, Setting, And Participants: This multicenter, retrospective cohort study included 972 VLBW infants treated in 6 US NICUs, with admission dates from January 1, 2006, to December 31, 2007. Data were collected from all infants until NICU discharge or death (last day of data collected, December 4, 2008). Data were entered into the central database, cleaned, and analyzed from May 1, 2009, to February 11, 2016.

Intervention: Platelet transfusion.

Main Outcomes And Measures: Number of platelet transfusions and incidence of IVH.

Results: Among the 972 VLBW infants (520 [53.5%] male; mean [SD] gestational age, 28.2 [2.9] weeks), 231 received 1002 platelet transfusions (mean [SD], 4.3 [6.0] per infant; range, 1-63 per infant). The pretransfusion PCT was at least 50 000/μL for 653 of 998 transfusions (65.4%) with this information. Two hundred eighty-one transfusions (28.0%) were given during the first 7 days of life. During that period, platelet transfusions were given on 35 of 53 days (66.0%) when the patient had a PCT less than 50 000/μL and on 203 of 436 days (46.6%) when the patient had a PCT of 50 000/μL to 99 000/μL. At least 1 marker of severe illness was present on 198 of 212 patient-days (93.4%) with thrombocytopenia (PCT, <100 000/μL) when a platelet transfusion was given compared with 113 of 190 patient-days (59.5%) with thrombocytopenia when no platelet transfusion was given. Thrombocytopenia was a risk factor for intraventricular hemorrhage during the first 7 days of life (hazard ratio, 2.17; 95% CI, 1.53-3.08; P < .001). However, no correlation was found between severity of thrombocytopenia and risk for IVH. After controlling for significant clinical factors and thrombocytopenia, platelet transfusions did not have a significant effect on the incidence of IVH (hazard ratio, 0.92; 95% CI, 0.49-1.73; P = .80).

Conclusions And Relevance: A large proportion of platelet transfusions were given to VLBW infants with PCT greater than 50 000/μL. Severity of illness influenced transfusion decisions. However, the severity of thrombocytopenia did not correlate with the risk for IVH, and platelet transfusions did not reduce this risk.

Citing Articles

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Prevalence and determinants of thrombocytopenia in newborn unit at Alexandria University Hospital: a three-year report including 1000 patients.

Farag M, Goda M, Nazir H, Deghedy A BMC Pediatr. 2024; 24(1):805.

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Implementing evidence-based restrictive neonatal intensive care unit platelet transfusion guidelines.

Christensen R, Bahr T, Davenport P, Sola-Visner M, Ohls R, Ilstrup S J Perinatol. 2024; 44(10):1394-1401.

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Consensus transfusion guidelines for a large neonatal intensive care network.

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Why might cord blood be a better source of platelets for transfusion to neonates?.

Cortesi V, Cavallaro G, Raffaeli G, Ghirardello S, Mosca F, Klei T Blood Transfus. 2024; 22(4):292-302.

PMID: 38557319 PMC: 11251836. DOI: 10.2450/BloodTransfus.566.

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