Red cell transfusion thresholds for preterm infants: finally some answers

2021 ◽  
pp. fetalneonatal-2020-320495
Author(s):  
Edward F Bell
Keyword(s):  
Neonatal Intensive Care ◽  
Primary Outcome ◽  
Low Birthweight ◽  
Newborn Infants ◽  
Packed Red Blood Cells ◽  
Cord Clamping ◽  
Umbilical Cord Clamping ◽  
Neurodevelopmental Impairment ◽  
Red Cell Transfusion ◽  
Extremely Low Birthweight

Extremely low birthweight infants become anaemic during their care in the neonatal intensive care unit because of the physiological anaemia experienced by all newborn infants compounded by early umbilical cord clamping, blood loss by phlebotomy for laboratory monitoring and delayed erythropoiesis. The majority of these infants receive transfusions of packed red blood cells, usually based on haemoglobin values below a certain threshold. The haemoglobin or haematocrit thresholds used to guide transfusion practices vary with infant status and among institutions and practitioners. Previous smaller studies have not given clear guidance with respect to the haemoglobin thresholds that should trigger transfusions or even if this is the best way to decide when to transfuse an infant. Two large clinical trials of similar design comparing higher and lower haemoglobin thresholds for transfusing extremely low birthweight infants were recently published, the ETTNO and TOP trials. These trials found reassuringly conclusive and concordant results. Within the range of haemoglobin transfusion thresholds studied, there was no difference in the primary outcome (which was the same in both studies), neurodevelopmental impairment at 2 years’ corrected age or death before assessment, in either study. In addition, there was no difference in either study in either of the components of the primary outcome. In conclusion, haemoglobin transfusion thresholds within the ranges used in these trials, 11–13 g/dL for young critically ill or ventilated infants and 7–10 g/dL for stable infants not requiring significant respiratory support, can be safely used without expecting adverse consequences on survival or neurodevelopment.

scholarly journals Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a ‘natural experiment’ allowing analysis of data from the prior two decades

2020 ◽  
Vol 5 (9) ◽  
pp. e003075 ◽  
Author(s):  
Roy K Philip ◽  
Helen Purtill ◽  
Elizabeth Reidy ◽  
Mandy Daly ◽  
Mendinaro Imcha ◽  
...  
Keyword(s):  
Poisson Regression ◽  
Rate Ratio ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Well Being ◽  
Very Low Birthweight ◽  
Live Births ◽  
Regional Trends ◽  
Extremely Low Birthweight ◽  
Health And Well Being

BackgroundAetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland’s response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants.MethodsRegional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020.ResultsPoisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001–2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500–600 range.ConclusionAn unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.

scholarly journals Perinatal quality improvement bundle to decrease hypothermia in extremely low birthweight infants with birth weight less than 1000 g: single-center experience over 6 years

2020 ◽  
Vol 68 (7) ◽  
pp. 1256-1260
Author(s):  
Dilip R Bhatt ◽  
Nirupa Reddy ◽  
Reynaldo Ruiz ◽  
Darla V Bustos ◽  
Torria Peacock ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Birth Weight ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Hospital Costs ◽  
Moderate Hypothermia ◽  
Quality Improvement Initiative ◽  
Single Center Experience ◽  
Continuous Quality ◽  
Extremely Low Birthweight

Normothermia (36.5°C–37. 5°C) at the time of admission to the neonatal intensive care unit (NICU) in extremely low birthweight (ELBW) infants (birth weight <1000 g) is associated with decreased morbidity and mortality, decreased length of stay and hospital costs. We designed a thermoregulation bundle to decrease hypothermia (<36.5°C) in ELBW infants with a multidisciplinary perinatal quality improvement initiative that included the following key interventions: dedicated delivery room (DR)/operating room (OR) for all preterm deliveries of ≤32 weeks with DR/OR temperature set 24/7 at 74°F by the hospital engineering staff, use of exothermic mattress, preheated radiant warmer set at 100% for heat prior to delivery, servo-controlled mode after the neonate is placed on the warmer, and use of plastic wrap, head cap and warm towels. A total of 200 ELBW infants were admitted to our NICU between January 1, 2014 and December 31, 2019. Hypothermia (<36.5°C) occurred in 2.5% of infants, normothermia (36.5°C–37.5°C) in 91% of infants and transitional hyperthermia (>37.5°C) in 6.5% of ELBW infants. No case of moderate hypothermia (32°C–36°C) was seen in our infants. Our target rate of less than 10% hypothermia was reached in ELBW infants over the last 2 years with no cases of moderate hypothermia in 6 years. Eliminating hypothermia among ELBW remains a challenge and requires team effort and continuous quality improvement efforts.

scholarly journals Plasma ammonia concentrations in extremely low birthweight infants in the first week after birth: secondary analysis from the ProVIDe randomized clinical trial

2020 ◽  
Vol 88 (2) ◽  
pp. 250-256 ◽  
Author(s):  
Barbara E. Cormack ◽  
Yannan Jiang ◽  
Jane E. Harding ◽  
Caroline A. Crowther ◽  
Adrienne Lynn ◽  
...  
Keyword(s):  
Gestational Age ◽  
Protein Intake ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Secondary Analysis ◽  
Ammonia Concentration ◽  
Plasma Ammonia ◽  
Arterial Blood ◽  
Birth Characteristics ◽  
Extremely Low Birthweight

Abstract Background Little is known about normative ammonia concentrations in extremely low birthweight (ELBW) babies and whether these vary with birth characteristics. We aimed to determine ammonia concentrations in ELBW babies in the first week after birth and relationships with neonatal characteristics and protein intake. Methods Arterial blood samples for the measurement of plasma ammonia concentration were collected within 7 days of birth from ProVIDe trial participants in six New Zealand neonatal intensive care units. Results Three hundred and twenty-two babies were included. Median (range) gestational age was 25.7 (22.7–31.6) weeks. Median (interquartile range (IQR)) ammonia concentration was 102 (80–131) µg/dL. There were no statistically significant associations between ammonia concentrations and birthweight or sex. Ammonia concentrations were weakly correlated with mean total (Spearman’s rs = 0.11, P = 0.047) and intravenous (rs = 0.13, P = 0.02) protein intake from birth, gestational age at birth (rs = −0.13, P = 0.02) and postnatal age (rs = −0.13, P = 0.02). Conclusions Plasma ammonia concentrations in ELBW babies are similar to those of larger and more mature babies and only weakly correlated with protein intake. Currently, recommended thresholds for investigation of hyperammonaemia are appropriate for ELBW babies. Protein intake should not be limited by concerns about potential hyperammonaemia.

A review of the risk of being born too soon

2002 ◽  
Vol 13 (3) ◽  
pp. 157-168 ◽  
Author(s):  
Janet M Rennie
Keyword(s):  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Burden Of Illness ◽  
Perinatal Care ◽  
Well Being ◽  
Good Health ◽  
Increased Risk ◽  
Extremely Low Birthweight ◽  
True Measure ◽  
Health And Well Being

The true measure of success or failure of perinatal care is not merely neonatal survival, but survival with good health and well-being into childhood and beyond. Quantifying this measure is important for all babies, particularly for those born prematurely. The risks are highest for those with a birthweight less than 1 kg (extremely low birthweight) and/or at less than 26 weeks gestation. There is continuing concern about the burden of illness and disability amongst survivors in this vulnerable group. However, we must not forget that all preterm infants are at increased risk of disability later in childhood and that the same is true for babies born at term who are sick enough to require neonatal intensive care.

scholarly journals Case Report: Treatment of Extremely Preterm Infants With Birthweight Below 300 g: Case Series

2021 ◽  
Vol 9 ◽  
Author(s):  
Yoshihiko Shitara ◽  
Satsuki Kakiuchi ◽  
Takeo Mukai ◽  
Kohei Kashima ◽  
Motohiro Kato ◽  
...  
Keyword(s):  
Best Practices ◽  
Low Birthweight ◽  
Clinical Course ◽  
Case Series ◽  
Hepatic Rupture ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurodevelopmental Impairment ◽  
Parental Counseling ◽  
Extremely Low Birthweight

Reports on the birth of infants weighing &lt;300 g are quite rare and little is known about the best practices in treating such micropreemies. Therefore, we report here on three cases of low birthweight infants weighing &lt;300 g, of whom two infants survived. The birthweights and gestational ages were ranging 279–293 g and 22 + 6/7 – 23 + 6/7 weeks, respectively. All the infants had severe fetal growth restriction and prematurity. The infant in case 1 died of hepatic rupture, perhaps due to birth trauma, which emphasized the need for less invasive obstetric procedures including en caul delivery. The infant in case 2 managed to survive through severe prematurity secondary to hydrops fetalis. However, complications followed soon as tracheal granulation tissue was formed with neurodevelopmental impairment. The infant in case 3 was born recently and her clinical course was less remarkable without severe complications, despite having the least gestational age and birthweight among the three patients. The improved care protocols for extremely low birthweight infants over these years through experiential learning including that with cases 1 and 2 may have ensured the better outcome of case 3. Accumulating evidence and recording the experience of such cases with continuous constructive discussion can contribute to better outcomes and appropriate parental counseling for extremely small babies in the future.

Sign in / Sign up

Export Citation Format

Share Document