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A randomized, controlled trial of platelet transfusions in thrombocytopenic premature infants
Insights
Early platelet concentrate transfusions did not significantly reduce intracranial hemorrhage in preterm infants with low platelets. However, treated infants required less blood product support, indicating potential benefits for bleeding complications.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Critical Care
Background:
- Thrombocytopenia is common in preterm infants, increasing the risk of intracranial hemorrhage (ICH).
- The efficacy of early platelet concentrate transfusions in preventing or reducing ICH in this population remains under investigation.
Purpose of the Study:
- To determine if early platelet concentrate administration reduces the incidence or extension of ICH in sick preterm infants with thrombocytopenia.
- To assess secondary outcomes including blood product support and bleeding time.
Main Methods:
- A multicenter prospective, randomized controlled trial.
- 22 preterm infants with platelet counts < 150 x 10(9)/L were randomized to conventional therapy or conventional therapy plus platelet concentrates (10 ml/kg).
- Platelet counts were maintained < 150 x 10(9)/L until day 7; ICH was assessed via ultrasonography.
Main Results:
- No significant difference in the incidence or extension of ICH between the treated (28%) and control (26%) groups (p = 0.73).
- Treated infants received less fresh frozen plasma and packed red blood cells compared to controls.
- Bleeding time was initially prolonged but subsequently shortened in the treated group.
Conclusions:
- Early platelet concentrate transfusions did not significantly decrease the rate of intracranial hemorrhage in preterm infants with thrombocytopenia.
- A trend towards reduced need for other blood products was observed in infants receiving early platelet support.
- Further research may be needed to clarify the role of platelet transfusions in managing bleeding risks in this vulnerable population.
Abstract:
A multicenter prospective, randomized controlled trial was conducted to determine whether early use of platelet concentrates would reduce the incidence or extension of intracranial hemorrhage or both in sick preterm infants with thrombocytopenia. The effects on bleeding as reflected by the amount of blood product support administered and a shortened bleeding time were assessed as secondary outcomes. Premature infants with a platelet count < 150 x 10(9)/L within the first 72 hours of life were randomly assigned to receive either conventional therapy or conventional therapy plus platelet concentrates (10 ml/kg). The platelet count was maintained < 150 x 10(9)/L until day 7 of life by one to three platelet transfusions. In 22 (28%) of the 78 treated infants and 19 (26%) of the 74 control infants, either a new intracranial hemorrhage developed or an already-present one became more extensive (p = 0.73). Similar numbers of infants had each grade of intracranial hemorrhage on both initial and follow-up ultrasonography. Similar numbers of infants received fresh frozen plasma and packed red blood cells, but treated infants received less of both. The bleeding time was prolonged in the treated group before the infusion of platelet concentrates but subsequently shortened (mean difference, 79.0; 95% confidence interval, 73.1 to 84.9). Subanalysis of the control group showed that infants with platelet counts < 60 x 10(9)/L (n = 21) on at least one occasion received more fresh frozen plasma and packed red blood cells than did those with platelet counts > 60 x 10(9)/L.(ABSTRACT TRUNCATED AT 250 WORDS)