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Temporal Trends in Red Blood Cell and Platelet Transfusion Thresholds for Extremely Low Birth Weight Infants
Ravi M Patel1, Jeanne E Hendrickson2, Rebecca Birch3
1Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
Insights
Hematologic thresholds for extremely low birth weight (ELBW) infants show declining red blood cell (RBC) transfusion levels but stable platelet transfusion levels. This suggests varied adoption of new transfusion evidence in clinical practice.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Clinical Transfusion Practices
Background:
- Evidence from randomized trials has informed new transfusion guidelines for extremely low birth weight (ELBW) infants.
- The impact of this evidence on clinical practice regarding transfusion thresholds remains to be fully elucidated.
- Understanding temporal trends in transfusion practices is crucial for optimizing care in vulnerable neonatal populations.
Purpose of the Study:
- To assess changes in hematologic thresholds for red blood cell (RBC) and platelet transfusions in ELBW infants.
- To determine if these thresholds evolved over time after the publication of key randomized trial evidence.
- To investigate if trends in transfusion thresholds varied by postnatal age.
Main Methods:
- Analysis of data from the REDS-IV-P study (April 2019-December 2023) involving 981 ELBW infants.
- Comparison of pre-transfusion hemoglobin and platelet counts within 24 hours of transfusion, analyzed by year.
- Linear mixed models used to identify trends over time and interactions with postnatal weeks.
Main Results:
- Pre-transfusion hemoglobin thresholds significantly declined over the study period (P<0.0001), with the most pronounced decrease observed from the third postnatal week onwards.
- No significant change in pre-transfusion platelet count thresholds was detected over time (P=0.24).
- While not statistically significant, pre-transfusion platelet counts were lower after the first postnatal week (P<0.001).
Conclusions:
- Observed declines in pre-transfusion hemoglobin thresholds but not platelet thresholds in US centers from 2019-2023.
- Findings suggest differential implementation of evidence from recent RBC and platelet transfusion trials into clinical practice for ELBW infants.
- Further research may be needed to understand the reasons for this differential adoption and its clinical implications.
Objective:
To evaluate if hematologic thresholds for red blood cell (RBC) and platelet transfusions changed over time following publication of new evidence from randomized trials in a multicenter cohort of extremely low birth weight (ELBW) infants.
Study Design:
We analyzed data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-IV-Pediatrics study from April 2019 through December 2023. We compared pretransfusion hemoglobin and platelet counts closest to each transfusion within 24 hours by year using linear mixed models and used model interaction terms to determine if trends over time differed by postnatal weeks.
Results:
We evaluated 981 ELBW infants. For trends in RBC transfusion thresholds, 785 infants (80%) received 5182 RBC transfusions, of which 4835 (93%) had a pretransfusion hemoglobin value. Pretransfusion hemoglobin declined over time (P < .0001), with trends differing by postnatal week (interaction P = .005). The greatest year-over-year decline in pretransfusion hemoglobin was in the third postnatal week or later. For platelet transfusions, 221 infants (23%) received 934 platelet transfusions, of which 900 (96%) had a corresponding pretransfusion platelet count. There was no change in pretransfusion platelet count over time (P = .24). These trends did not differ by postnatal week (interaction P = .14), although pretransfusion platelet counts were lower after the first postnatal week (P < .001).
Conclusions:
In this cohort of US centers, we observed declines in pretransfusion hemoglobin but not pretransfusion platelet counts from 2019 to 2023. These findings suggest evidence from recent RBC and platelet transfusion threshold trials may have been differentially translated into clinical practice for ELBW infants.
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