Elsevier

The Journal of Pediatrics

Volume 129, Issue 5, November 1996, Pages 680-687
The Journal of Pediatrics

Changing patterns of red blood cell transfusion in very low birth weight infants,☆☆,,★★

https://doi.org/10.1016/S0022-3476(96)70150-6Get rights and content

Abstract

OBJECTIVE: Anemia develops in increasing numbers of critically ill very low birth weight (VLBW) infants who survive the neonatal period, and they receive multiple red blood cell (RBC) transfusions. Despite their need for prolonged medical treatment, we hypothesized that VLBW infants presently receive fewer RBC transfusions as a result of the growing awareness of transfusion risks and improvement of neonatal care. METHODS: RBC transfusion practices and clinical outcomes in infants with birth weights of 1.5 kg or less were analyzed retrospectively in three selected years: 1982, before awareness of the human immunodeficiency virus; 1989, before surfactant availability; and 1993, before erythropoietin approval. RESULTS: Progressive declines in RBC transfusions, donor exposures, and transfusion volumes occurred concurrently with decreases in morbidity and mortality rates. Transfusions per infant (mean ± SD) declined from 7.0 ± 7.4 in 1982 to 5.0 ± 5.8 in 1989 to 2.3 ± 2.7 in 1993 (p <0.001). This decline was associated with a decrease in pretransfusion hematocrit (33.6% ± 2.8% in 1982, 34.2% ± 3.7% in 1989, and 29.8% ± 5.1% in 1993; p <0.001). The distribution of RBC transfusions given by week of life among study years did not change; 70% of RBC transfusions were given within the first 4 weeks, when infants are sickest. Although the percentage of VLBW infants weighing more than 1 kg at birth and never receiving any RBC transfusions increased with time (17% in 1982, 33% in 1989, and 64% in 1993), more than 95% of infants weighing 1 kg or less in all years received transfusions. CONCLUSIONS: Overall administration of neonatal transfusions has decreased markedly, most likely because of multiple factors. Because most RBC transfusions are given to infants weighing 1 kg or less in the first weeks of life, therapeutic strategies should focus on this group of VLBW infants during this critical period. The temporal changes observed in transfusion patterns emphasize the importance of including concurrent controls in future studies evaluating transfusion interventions. (J Pediatr 1996;129:680-7)

Section snippets

Protocol design

Changes in the pattern of administering RBC transfusions to VLBW infants admitted to our nursery were assessed for the past 12 years by retrospectively examining blood bank and hospital records. Three study years were selected to encompass major events having a potential impact on RBC transfusion practices. The first year selected, 1982, immediately preceded widespread awareness of human immunodeficiency virus. The second year, 1989, preceded implementation of major changes in the prevention

RESULTS

General characteristics indicative of the degree of prematurity and clinical condition at birth were similar for each of the 3 study years (Table I). The only exceptions were a greater proportion of girls in 1989 than in 1993, and a lower initial postdelivery hemoglobin concentration in 1989 than in 1982. Although Apgar scores at 1 and 5 minutes were not different (data not shown), the infant mortality rate before 2 weeks of age was significantly lower in 1993 than in either 1982 or 1989 (p

DISCUSSION

During the 12 years from 1982 to 1993, we observed a 30% decline in the number of infants weighing 1.5 kg or less who received one or more RBC transfusions, a 67% reduction in the number of transfusions administered per infant, and a 54% decrease in the number of donor exposures per infant before hospital discharge or transfer. These events occurred during a period of improving survival and outcome. Although surveys of RBC transfusions done in the 1970s and 1980s noted a reduction in the number

Acknowledgements

We acknowledge the skillful assistance of Christopher J. McDonald, Terrie L. James, RN, June E. Miller, RN, and Karen J. Johnson, RN, in data collection. Encouragement and helpful suggestions were provided by Charles A. J. Wardrop, MB, FRCPE, FRCPATH.

References (34)

  • GJ Levy et al.

    National survey of neonatal transfusion practices. I. Red blood cell therapy

    Pediatrics

    (1993)
  • VS Blanchette et al.

    Assessment of anemia in newborn infants

    Clin Perinatol

    (1984)
  • RG Strauss et al.

    Sterility and quality of blood dispensed in syringes and quality of blood dispensed in syringes for infants

    Transfusion

    (1986)
  • KM Shannon et al.

    Recombinant human erythropoietin stimulates erythropoiesis and reduces erythrocyte transfusions in very low birth weight preterm infants

    Pediatrics

    (1995)
  • BJ. Winer

    Statistical principles in experimental design

  • ME. Wegman

    Annual summary of vital statistics-1993

    Pediatrics

    (1994)
  • P Crowley et al.

    The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials

    Br J Obstet Gynaecol

    (1990)
  • Cited by (0)

    From the Departments of Pediatrics, Preventive Medicine, and Pathology, University of Iowa, Iowa City

    ☆☆

    Supported by National Institutes of Health grant PO1 HL46925.

    Reprint requests: John A. Widness, MD, Department of Pediatrics, University of Iowa, Iowa City, IA 52242.

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    0022-3476/96/$5.00 + 0 9/21/75549

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