Platelet transfusion in neonatal intensive care units of 22 European countries: a prospective observational study

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2024-10-10 DOI:10.1016/j.lanepe.2024.101086

Nina A.M. Houben , Enrico Lopriore , Karin Fijnvandraat , Camila Caram-Deelder , Marta Aguar Carrascosa , Alain Beuchée , Kristin Brække , Francesco Cardona , Anne Debeer , Sara Domingues , Stefano Ghirardello , Ruza Grizelj , Emina Hadžimuratović , Christian Heiring , Jana Lozar Krivec , Jan Malý , Katarina Matasova , Carmel Maria Moore , Tobias Muehlbacher , Miklos Szabó , Lorenzo Zanetto

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引用次数: 0

Abstract

Background

Platelet transfusions are given to preterm infants with severe thrombocytopenia aiming to prevent haemorrhage. The PlaNeT2/MATISSE trial revealed higher rates of mortality and/or major bleeding in preterm infants receiving prophylactic platelet transfusions at a platelet count threshold of 50 × 10⁹/L compared to 25 × 10⁹/L. The extent to which this evidence has been incorporated into clinical practice is unknown, thus we aimed to describe current neonatal platelet transfusion practices in Europe.

Methods

We performed a prospective observational study in 64 neonatal intensive care units across 22 European countries between September 2022 and August 2023. Outcome measures included observed transfusion prevalence rates (per country and overall, pooled using a random effects Poisson model), expected rates based on patient-mix (per country, estimated using logistic regression), cumulative incidence of receiving a transfusion by day 28 (with death and discharge considered as competing events), transfusion indications, volumes and infusion rates, platelet count triggers and increment, and adverse effects.

Findings

We included 1143 preterm infants, of whom 71 (6.2%, [71/1143]) collectively received 217 transfusions. Overall observed prevalence rate was 0.3 platelet transfusion days per 100 admission days. By day 28, 8.3% (95% CI: 5.5–11.1) of infants received a transfusion. Most transfusions were indicated for threshold (74.2%, [161/217]). Pre-transfusion platelet counts were above 25 × 10⁹/L in 33.1% [53/160] of these transfusions. There was significant variability in volume and duration.

Interpretation

The restrictive threshold of 25 × 10⁹/L is being integrated into clinical practice. Research is needed to explore existing variation and generate evidence for various aspects including optimal volumes and infusion rates.

Funding

Sanquin, EBA, and ESPR.

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22 个欧洲国家新生儿重症监护室的血小板输注：前瞻性观察研究

背景血小板严重减少的早产儿输注血小板的目的是预防大出血。PlaNeT2/MATISSE 试验显示，在血小板计数阈值为 50 × 109/L 时，接受预防性血小板输注的早产儿死亡率和/或大出血率高于 25 × 109/L。我们在 2022 年 9 月至 2023 年 8 月期间对 22 个欧洲国家的 64 个新生儿重症监护病房进行了前瞻性观察研究。结果指标包括观察到的输血率（每个国家和总体，使用随机效应泊松模型汇总）、基于患者组合的预期输血率（每个国家，使用逻辑回归估算）、第 28 天前接受输血的累积发生率（死亡和出院被视为竞争事件）、输血适应症、输血量和输注率、血小板计数触发和增量以及不良反应。研究结果我们纳入了 1143 例早产儿，其中 71 例（6.2%，[71/1143]）共接受了 217 次输血。总体观察流行率为每 100 个入院日中有 0.3 个血小板输注日。到第 28 天，8.3%（95% CI：5.5-11.1）的婴儿接受了输血。大多数输血用于阈值（74.2%，[161/217]）。输血前血小板计数超过 25 × 109/L 的占 33.1% [53/160]。解释 25 × 109/L 的限制性阈值正被纳入临床实践。需要开展研究以探索现有的差异，并为包括最佳输液量和输液速度在内的各个方面提供证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.