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Selective prophylactic solvent-detergent plasma and cryoprecipitate transfusion to prevent intraventricular

S Al-Abdi1, K Dabelah1, T Mousa1

  • 1King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Science, Department of Pediatrics, King Abdulaziz Hospital, Ministry of National Guard Hospital, Al-Ahsa, Saudi Arabia.

Journal of Neonatal-Perinatal Medicine
|October 5, 2018
PubMed

Insights

Selective prophylactic transfusion of solvent-detergent plasma and cryoprecipitate within 12 hours of life may reduce intraventricular hemorrhage (IVH) in extreme preterm infants (EPI). Further trials are needed to confirm benefits and risks.

Area of Science:

  • Neonatal Medicine
  • Pediatric Hematology
  • Clinical Research

Background:

  • Intraventricular hemorrhage (IVH) is a significant concern in extreme preterm infants (EPI).
  • Evidence is conflicting regarding the efficacy of prophylactic coagulation factor transfusion in preventing IVH in EPI within the first hours of life (HOL).

Purpose of the Study:

  • To evaluate the effectiveness of selective prophylactic solvent-detergent plasma and cryoprecipitate transfusion (SP-SDP/Cryoprecipitate-T) within 12 hours of life in preventing IVH in EPI.
  • To compare IVH rates between a period of selective prophylactic transfusion and a period of rescue transfusion.

Main Methods:

  • Retrospective analysis of prospectively collected data from a Saudi tertiary neonatal intensive care unit.
  • Case-historical control study comparing EPI born during 2010-2013 (SP-SDP/Cryoprecipitate-T period) with those born during 2006-2009 (rescue SDP/Cryoprecipitate-T period).

Main Results:

  • The IVH rate was significantly lower in the selective prophylactic transfusion period (30.8%) compared to the rescue transfusion period (51.2%).
  • The observed difference in IVH rates remained statistically significant after adjusting for six other identified IVH risk factors (OR 0.42, 95% CI 0.21-0.88, p=0.02).

Conclusions:

  • Early selective prophylactic transfusion of solvent-detergent plasma and cryoprecipitate may decrease the incidence of IVH in extreme preterm infants.
  • A large multicenter clinical trial is warranted to definitively establish the short- and long-term benefits and risks of this intervention.
  • Institutions with high IVH rates may consider early selective prophylactic transfusion pending further evidence.
Abstract

Keywords:
Extreme preterm infantcoagulopathycryoprecipitatefresh frozen plasmaintraventricular hemorrhagesolvent-detergent plasma

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