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Survey of transfusion practices in preterm infants in Europe
  1. Alexandra Scrivens1,
  2. Nora Johanna Reibel2,
  3. Lisanne Heeger3,4,
  4. Simon Stanworth5,
  5. Enrico Lopriore3,
  6. Helen V New6,
  7. Christof Dame7,
  8. Karin Fijnvandraat4,8,
  9. Emöke Deschmann9,
  10. Marta Aguar10,
  11. Kristin Brække11,
  12. Francesco Stefano Cardona12,
  13. Filip Cools13,
  14. Ryan Farrugia14,
  15. Stefano Ghirardello15,
  16. Jana Lozar16,
  17. Katarina Matasova17,
  18. Tobias Muehlbacher18,
  19. Ulla Sankilampi19,
  20. Henrique Soares20,
  21. Miklos Szabo21,
  22. Tomasz Szczapa22,
  23. Gabriela Zaharie23,
  24. Charles Christoph Roehr24,25,
  25. Suzanne Fustolo-Gunnink4,26,27
  26. On behalf of the Neonatal Transfusion Network
  1. 1 Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
  3. 3 Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
  4. 4 Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
  5. 5 Department of Haematology, National Health Service, Blood and Transplant, Oxford University Hopsitals NHS Foundation Trust, Oxford, UK
  6. 6 Paediatric Transfusion Medicine, National Health Service, Blood and Transplant, London, UK
  7. 7 Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
  8. 8 Pediatrics, Emma Children’s Hospital, Pediatric Hematology, University of Amsterdam, Amsterdam, The Netherlands
  9. 9 University Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
  10. 10 Servicio de Neonatologia, University & Polytechnic Hospital La Fe, Valencia, Spain
  11. 11 Women and Children’s division, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway
  12. 12 Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Pediatric Neurology, Medical University of Vienna, Wien, Austria
  13. 13 Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
  14. 14 Pediatrics, Mater Dei Hospital, Msida, Malta
  15. 15 Neonatal Intensive Care and Neonatology Unit, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  16. 16 Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  17. 17 Jessenius Faculty of Medicine in Martin, University Hospital Martin, Martin, Slovakia
  18. 18 Neonatology, University Hospital Zurich, Zurich, Switzerland
  19. 19 Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
  20. 20 Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
  21. 21 Division of Neonatology 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
  22. 22 II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
  23. 23 Neonatology, University of Medicine and Pharmacy Iuliu Hatieganu Cluj, Cluj Napoca, Romania
  24. 24 National Perinatal Epidemiology Unit, Clinical Trials Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
  25. 25 Women and Children's, Neonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  26. 26 Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
  27. 27 Pediatric Hematology, Amsterdam University Medical Center, Amsterdam, Netherlands
  1. Correspondence to Dr Charles Christoph Roehr, Clinical Trials Unit, National Perinatal Epidemiology Unit, Oxford OX3 7LF, UK; charles.roehr{at}npeu.ox.ac.uk

Abstract

Background Preterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data.

Methods From October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries.

Results Responses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×109/L in non-bleeding infants of GA of <28 weeks, while the 25×109/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs.

Conclusions Transfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice.

  • neonatology
  • child health
  • data collection
  • epidemiology
  • healthcare disparities

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request by email to the corresponding and the senior author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2022-324619

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request by email to the corresponding and the senior author.

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    Footnotes

    • Twitter @dralexscrivens, @fracardo

    • Collaborators The study was conducted by the executive council members and other members of the Neonatal Transfusion Network (NTN). The NTN is an interdisciplinary, international research network focused on optimising neonatal transfusion practices and research worldwide. It is governed by a steering board and includes over 130 members from over 35 countries. The network is endorsed by the European Society for Pediatric Research, the European Blood Alliance, the European Foundation for the Care of Newborn Infants and the International Hemovigilance Network (www.neonataltransfusionnetwork.com).

    • Contributors The study was planned and executed by the members of the Neonatal Transfusion Network steering committee (CCR, CD, ED, EL, HVN, JvbB, KF, SS, SFG, AS, HS, LH, NH and NJR) with significant input from MAC, KB, FSC, FC, RF, SGh, JL, KM, TM, US, HS, MS, TS and GZ, who also facilitated region-specific data collection. S F-G is guarantor.

    • Funding The study was in part funded by the generous support and grant (PPOC21-08/L2588 and RES/00264) from Sanquin Blood Supply Foundation, Amsterdam, the Netherlands, and a postdoctoral research grant (RGP2020-09/PDRG-02/04) from The European Society for Pediatric Research, Geneva, Switzerland.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.