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Published on: November 20, 2015
[Anemia of prematurity: risk factors influencing red cell transfusions]
A A Zuppa1, M Mazzotta, G Maragliano
1Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, Roma.
Insights
Premature infants born before 30 weeks or weighing under 1000g, especially those with severe illness, often require packed red cell (PRC) transfusions. Early transfusions increase the need for later ones, suggesting erythropoietin as an alternative.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
Context:
- Premature infants face significant risks, including anemia, necessitating interventions like packed red cell (PRC) transfusions.
- Transfusion practices in neonatal intensive care units (NICUs) require careful evaluation to optimize patient outcomes.
Purpose:
- To determine the significance of packed red cell (PRC) transfusion practices in premature infants.
- To identify key risk factors influencing the frequency and necessity of PRC transfusions in this vulnerable population.
Summary:
- A study of 75 preterm infants revealed that 70.7% received PRC transfusions.
- Factors increasing transfusion needs included gestational age ≤30 weeks, birth weight ≤1000g, and severe neonatal pathology (respiratory disease or sepsis).
- Repeated early transfusions correlated with a higher need for late transfusions, highlighting potential candidates for recombinant human erythropoietin therapy.
Impact:
- Identifies specific preterm infant subgroups (gestational age <30 weeks, birth weight <1000g, severe respiratory/infectious disease) as candidates for erythropoietin.
- Suggests that early packed red cell (PRC) transfusions may predict the need for later transfusions, impacting long-term anemia management.
- Provides evidence to guide transfusion strategies and explore alternative therapies like erythropoietin to reduce transfusion dependency in premature infants.
Abstract:
To investigate the importance of transfusion practice with packed red cells (PRCs) in premature infants and to identify risk factors significant influencing transfusion practice, we analyzed 75 preterm infants (gestational age: 31 +/- 2 weeks; birth weight: 1459 +/- 402 g) admitted to the neonatal intensive care unit of Catholic University of Rome. Fifty-three (70.7%) of the infants received one or more PRCs transfusions (in total 246 transfusions). The variables associated with an increase in number and frequency of PRCs transfusions were: a) gestational age < or = 30 weeks; b) birth weight < or = 1000 g; c) severe neonatal pathology (ie a respiratory disease requiring ventilatory support and/or a clearly documented or suspected sepsis). Repeated PRCs transfusions during the first week of life significantly (p < 0.01) influenced the need for late transfusions, after 4 weeks of age, for the treatment of the anemia of prematurity. These data indicate that preterm infants with a gestational age < or = 30 weeks, a birth weight < 1000 g and a severe respiratory or infectious disease represent natural candidates for administration of recombinant human erythropoietin to reduce the need for late PRCs transfusions.
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