Temporal Trends in Red Blood Cell and Platelet Transfusion Thresholds for Extremely Low Birth Weight Infants

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.