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Published on: December 31, 2015
Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study
Marwa M Elgendy1, Ryan Durgham1, Hasan F Othman2
1Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
Insights
Platelet transfusions in preterm infants with thrombocytopenia are linked to higher mortality and complications. This practice has also increased over time, despite potential risks.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Critical Care
Background:
- Prophylactic platelet transfusion is a common practice for thrombocytopenic preterm infants to prevent bleeding.
- The efficacy and safety of this ubiquitous practice warrant further investigation.
Purpose of the Study:
- To determine the prevalence of platelet transfusion in preterm infants with thrombocytopenia.
- To evaluate the association between platelet transfusion and mortality and morbidity in this vulnerable population.
Main Methods:
- A cross-sectional study using the National Inpatient Sample (2000-2017).
- Included preterm infants with birth weight <1,500 g or gestational age <32 weeks.
- Logistic regression analysis adjusted for confounding variables, with stratification by birth weight (<1,000 g and 1,000-1,499 g).
Main Results:
- Over 1.78 million infants were analyzed; 1.27% had thrombocytopenia, and 22.7% received platelet transfusions.
- Platelet transfusion was associated with increased mortality (24.8% vs. 13.8%), retinopathy of prematurity, severe intraventricular hemorrhage, longer hospital stays, and higher costs.
- Increased mortality was observed in both low birth weight categories (<1,000 g and 1,000-1,499 g) with transfusion.
Conclusions:
- Platelet transfusion in preterm infants with thrombocytopenia is associated with heightened mortality and comorbidities.
- The utilization of platelet transfusions has shown an increasing trend over the study period.
Background:
Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding.
Objectives:
The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population.
Methods:
A cross-sectional study that utilized National Inpatient Sample for the years 2000-2017 was conducted. All preterm infants delivered nationally with birth weight (BW) <1,500 g or gestational age <32 weeks were included. Analyses were repeated after stratifying the population into 2 BW subcategories <1,000 g and 1,000-1,499 g. Logistic regression analysis was performed to adjust for confounding variables.
Results:
The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in <1,000-g infants (aOR = 1.96, CI: 1.76-2.18, p < 0.001) and 1,000-1,499-g infants (aOR = 2.02, CI: 1.62-2.53, p < 0.001). Platelet transfusion increased over the years in infants with BW <1,000 g (p = 0.001) and in infants with BW 1,000-1,499 g (p < 0.001).
Conclusions:
Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.
