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Decreasing Blood Transfusions in Premature Infants Through Quality Improvement.

Kwai Tei C Chan Poon1, Lusia Li1, Rick Pittman1

  • 1Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina.

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Summary

This study reduced packed red blood cell transfusions (pRBCT) in preterm infants (26-34 weeks gestation) by 46.6%. Quality improvement strategies successfully decreased transfusions without impacting mortality or necrotizing enterocolitis.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Hematology
  • Quality Improvement Science

Background:

  • Packed red blood cell transfusions (pRBCT) are common in preterm infants and associated with morbidity.
  • Preterm infants between 26 and 34 weeks' gestational age may receive preventable pRBCT.
  • Reducing pRBCT in this population is a key quality improvement goal.

Purpose of the Study:

  • To decrease pRBCT in preterm infants (26-34 weeks gestation) by 20% using quality improvement methods.
  • To implement evidence-based transfusion guidelines and supportive therapies.
  • To monitor transfusion rates and related process measures.

Main Methods:

  • A quality improvement project was conducted in a Neonatal Intensive Care Unit (NICU) from July 2018 to February 2023.
  • Interventions included evidence-based transfusion thresholds, erythropoiesis support, and reduced laboratory draw volumes.
  • Statistical process control charts monitored pRBCT rates, erythropoietin use, and laboratory panel utilization.

Main Results:

  • pRBCT decreased by 46.6%, from 23.8 to 12.7 transfusions per 1000 patient days.
  • Erythropoietin use and capillary panel testing increased; basic metabolic panel use decreased.
  • No significant changes were observed in mortality or necrotizing enterocolitis rates.
  • The observed improvements were sustained for 24 months.

Conclusions:

  • A combination of quality improvement strategies can significantly decrease pRBCT in preterm infants (26-34 weeks gestation).
  • These interventions are effective and sustainable.
  • This approach offers a viable method for reducing transfusion-related risks in this vulnerable population.