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Original research
Red blood cell transfusions in neonatal intensive care units: a nationwide observational cohort study
  1. Lisanne Elise Heeger1,2,
  2. Camila Caram-Deelder3,
  3. Suzanne Gunnink1,4,
  4. F Cassel5,
  5. Esther J d'Haens6,
  6. Christian V Hulzebos7,
  7. Ellen de Kort8,
  8. Wes Onland9,10,
  9. S Prins11,
  10. Daniel C Vijlbrief12,
  11. Sabine L Vrancken13,
  12. Elke van Westering-Kroon14,
  13. Johanna G van der Bom3,
  14. Enrico Lopriore15
  1. 1Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
  3. 3Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Sanquin Bloedvoorziening, Amsterdam, The Netherlands
  5. 5Department of Neonatal and Pediatric Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
  6. 6Princess Amalia Department of Paediatrics, Department of Neonatology, Isala Clinics, Zwolle, The Netherlands
  7. 7Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
  8. 8Neonatolgy, Maxima Medical Center, Veldhoven, The Netherlands
  9. 9Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  10. 10Amsterdam Reproduction and Development, Amsterdam, The Netherlands
  11. 11Department of Pediatrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
  12. 12Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
  13. 13Amalia Children's Hospital, Division of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
  14. 14MosaKids Childrens Hospital, Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
  15. 15Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to Lisanne Elise Heeger; l.e.heeger{at}lumc.nl

Abstract

Objective To describe the use and nationwide variation of red blood cell (RBC) transfusions in neonatal intensive care units (NICUs) following the introduction of the revised national transfusion guideline in 2019.

Design and patients We randomly selected neonates born below 32 weeks’ gestation admitted to any NICU in the Netherlands in 2020 to include in our retrospective observational cohort study.

Main outcome measures Main outcome measures were the number of neonates receiving at least one transfusion, and the number of transfusions per transfused neonate.

Results Of 762 neonates included, 34% (257/762) received at least one RBC transfusion, varying between centres from 20% (12/61) to 50% (39/77). Median phlebotomy loss during admission was 8.2 mL/kg (IQR 4.5–17.3 mL/kg), equating to 54.3% of the median transfusion volume. Of 770 transfusions, 358 (47%) were administered above the recommended threshold, and the proportion of transfusions given above the threshold varied between centres from 15% to 719%. Median transfusion dosage and mean infusion duration were 15.1 mL/kg (IQR 15.0–16.7 mL/kg) and 3.9 hours (SD 1.1 hour) and varied from 14.8 mL/kg to 18.9 mL/kg and from 2.5 hours to 5.5 hours between centres. Blood transfusion volume was positively correlated with cumulative volume of blood draws (Pearson correlation coefficient 0.84, 95% CI 0.82 to 0.86) and lower gestation.

Conclusions Large variation in transfusion practice remains between Dutch NICUs despite a national guideline. Extreme prematurity and cumulative blood draws were associated with increased use of RBC transfusions. Benchmarking will yield leverage points to understand and potentially prevent unwarranted variation.

  • Epidemiology
  • Intensive Care Units, Neonatal
  • Neonatology

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/archdischild-2024-327441

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @vijlbrief01

    • Contributors Conceptualisation: LEH, CC-D, SG, JGvdB, EL. Data curation: LEH. Formal analysis: LEH, CC-D. Funding acquisition: JGvdB, EL. Methodology: LEH, CC-D, JGvdB, EL. Project administration: LEH. Supervision: CC-D, JGvdB, EL. Validation: LEH, CC-D. Visualisation: LEH, CC-D, JGvdB, EL. Writing original draft: LEH, CC-D, JGvdB, EL. Writing review and editing: LEH, CC-D, SG, FC, EjdH, CVH, EdK, WO, SP, DCV, EvW-K, JGvdB, EL. Guarantor: EL.

    • Funding This study was funded by Sanquin Blood Supply Foundation (PPOC20-26 L2524)

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.