Anaemia of prematurity is, in part, an exacerbation of the physiological anaemia of the newborn, combining a suppressed postnatal response to erythropoietin, increased blood Sampling, short RBC span in the newborn and the rapid increase in blood volume with growth. The rapid decline in haemoglobin concentration is most severe in infants of smaller gestational age Most neonatal blood transfusions are administered to maintain minimal, although ill-defined, levels of haemoglobin. Maintenance or ‘topup’ transfusions are triggered by haemoglobin thresholds, which have been compared during clinical trials. the largest trial made is (the Premature Infants in Need of Transfusion [PINT] study), Which concluded that the use of restrictive versus liberal transfusion practices does not appear to have a significant impact on the combined outcomes of mortality or major morbidities.
aim: implement local nicu guidlines based on pint study guidlines.
‘Retrospective data collection from records of transfused preterm babies within the last year (April 2015 to April 2016). From these records, the Hb level at which babies were transfused was identified, the age and CGA at transfusion and whether the baby was on respiratory support or not.
guidlines used in PINT study:‘
Postnatal age Respiratory support* No respiratory support Week 1 115 (35) 100 (30)
Week 2 100 (30) 85 (25)
Week 3 and older 85 (25) 75 (25)
Exclusions criteria -Any transfusion other than packed RBCs.
-Acute blood loss or haemorrhage
-Term babies. Results:
Number of transfusions done with Hb level above the recommended for transfusion: 14/28
Number of transfusions done with Hb level below or within the recommended for transfusion: 14/28
Conclusion 50% of preterm babies transfused with PRBCS due to low Hb were transfused at higher Hb than recommended for transfusion(early transfusion).
Based on PINT study: if the guidelines used in the study is implemented, that will decrease the hazards of blood transfusion by 50% inpreterms with anaemia of prematurity.
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