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Red Blood Cell Transfusion in European Neonatal Intensive Care Units, 2022 to 2023
Nina A M Houben1,2, Suzanne Fustolo-Gunnink1,2,3, Karin Fijnvandraat3,4
1Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands.
JAMA Network Open
|September 19, 2024
Summary
Most red blood cell (RBC) transfusions in very preterm infants were given when hemoglobin levels were above restrictive thresholds. This highlights a gap between clinical practice and evidence from trials like ETTNO and TOP, suggesting a need for optimized transfusion protocols.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Clinical Practice Research
Background:
- Red blood cell (RBC) transfusions are common in very preterm infants.
- Recent trials (ETTNO, TOP) found liberal RBC transfusion thresholds are not superior to restrictive ones.
- Current clinical practice integration of these findings is unknown.
Purpose of the Study:
- To describe current neonatal RBC transfusion practices in Europe.
- To assess adherence to evidence-based transfusion thresholds in preterm infants.
Main Methods:
- International prospective observational cohort study.
- Data collected from 64 NICUs in 22 European countries (Sept 2022 - Aug 2023).
- Included 1143 preterm infants (born < 32 weeks gestation).
Main Results:
- 36.5% of infants received at least one RBC transfusion by day 28.
- Most transfusions (82.8%) were based on hemoglobin (Hb) thresholds.
- A significant proportion of transfusions (44.4%-48.3%) occurred with Hb levels above restrictive thresholds from ETTNO/TOP trials.
Conclusions:
- Transfusion practices in very preterm infants often exceed restrictive thresholds established by recent trials.
- There is a need to optimize RBC transfusion protocols and support the implementation of evidence-based guidelines.
- Further research is needed to understand and improve the uptake of trial findings into clinical practice.
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