Effects of blood sampling stewardship and erythropoietin administration in extremely low birth weight infants—a quality improvement non-controlled before-and-after retrospective study
- 19 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Journal of Pediatrics
- Vol. 180 (5), 1617-1626
- https://doi.org/10.1007/s00431-020-03925-9
Abstract
The majority of extremely low birth weight (ELBW) neonates receive red blood cell (RBC) transfusions; at least 50% receive multiple transfusions. Anemia care bundles could be the most effective approach to reduce transfusion rates. We conducted a quality improvement non-controlled before-and-after retrospective study involving 345 ELBW infants admitted over a 5-year period in two consecutive epochs before and after implementation of an anemia care bundle in January 2017. Bundle components included (a) prophylactic subcutaneous erythropoietin twice each week (600 IU/kg/week) from day 7 through 8 weeks of age and (b) blood sampling stewardship in the first five postnatal weeks. Early postnatal blood sampling losses were significantly reduced following the implementation of the care bundle (21.2 ml/kg vs 25 ml/kg, P < 0.001). We found a 50% reduction in the rate of multiple RBC transfusions (adjusted RR 0.45, 95% CI: 0.34–0.59) and a reduced odds of necrotizing enterocolitis (NEC) (4% vs 10%, adjusted OR 0.38 (95% CI: 0.15–0.78)) among infants that received the anemia care bundle (n = 182 infants). The overall transfusion rate, number and volume of transfusions, and multiple donor exposures were also significantly reduced. Conclusion: The combination of extended subcutaneous erythropoietin administration and reduced early postnatal blood sampling was associated with a significant reduction in the rate of multiple erythrocyte transfusions and NEC in ELBW neonates. What is known: • The majority of extremely low birth weight neonates continue to require blood transfusions despite advances in standardized transfusion practices; at least 50% require multiple transfusions. • Anemia care bundles, employing a combination of anemia prevention strategies, can effectively reduce the RBC transfusion rates in ELBW infants. What is new: • A combination of extended subcutaneous erythropoietin supplementation and blood sampling stewardship practices reduced the rate of multiple RBC transfusions in ELBW neonates by 50%. • Implementation of the anemia care bundle was associated with a significant reduction in the rates of necrotizing enterocolitis.Keywords
This publication has 35 references indexed in Scilit:
- Uncontrolled before-after studies: discouraged by Cochrane and theEMJEmergency Medicine Journal, 2015
- Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in CanadaTransfusion, 2015
- Why do four NICUs using identical RBC transfusion guidelines have different gestational age-adjusted RBC transfusion rates?Journal of Perinatology, 2014
- Pharmacodynamically optimized erythropoietin treatment combined with phlebotomy reduction predicted to eliminate blood transfusions in selected preterm infantsPediatric Research, 2013
- Implementation of a multi-parameter Point-of-Care-blood test analyzer reduces central laboratory testing and need for blood transfusions in very low birth weight infantsClinica Chimica Acta; International Journal of Clinical Chemistry, 2012
- Red Blood Cell Transfusions are Independently Associated with Intra-Hospital Mortality in Very Low Birth Weight Preterm InfantsThe Journal of Pediatrics, 2011
- The premature infants in need of transfusion (pint) study: A randomized, controlled trial of a restrictive (LOW) versus liberal (HIGH) transfusion threshold for extremely low birth weight infantsThe Journal of Pediatrics, 2006
- Reduction in Red Blood Cell Transfusions Among Preterm Infants: Results of a Randomized Trial With an In-Line Blood Gas and Chemistry MonitorPEDIATRICS, 2005
- Reduction in Red Blood Cell Transfusions Using a Bedside Analyzer in Extremely Low Birth Weight InfantsJournal of Perinatology, 2004
- Hepatic iron storage in very low birthweight infants after multiple blood transfusionsArchives of Disease in Childhood: Fetal & Neonatal, 2001