TITLE:
Categorization and Frequency of Indications for Packed Cell Transfusion in the Preterm Newborn during the Initial Hospital Stay at a Tertiary Care Hospital: A Cross-Sectional Study
AUTHORS:
Shirin Surani, Heeramani Lohana, Sheraz Ahmed, Rabia Hassan, Sapna Kewalani, Khalil Ahmed
KEYWORDS:
Packed Cell Transfusion, Preterm, Neonatal Intensive Care Unit, Anemia of Prematurity, Phlebotomy Losses
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.11 No.4,
December
22,
2021
ABSTRACT: Introduction: Packed cell transfusion is a lifesaving procedure in premature babies as
they have more complications as compared to babies who are born at term.
Complications related to prematurity increase as gestational age decreases and
anemia is one of the complications of prematurity which needs packed cell
transfusions. To date, when to transfuse preterm babies and what would be the
threshold for hemoglobin and hematocrit is still a point of argument as well as
liberal versus restrictive transfusion protocols have been developed but what should
be followed still needs more data. In our study, we have observed frequencies
of different indications of packed cell transfusion in the neonatal intensive
care unit of a tertiary care hospital. This endeavor will help in the
establishment of guidelines regarding transfusion and the threshold on which
any intervention should be done also it would be a step towards the
identification of preventable causes that lead to transfusion and
transfusion-related risks and hazards. Objective: To determine the indication of packed cell
transfusion and their frequencies in preterm neonates. Study
Design: This was a cross-sectional
study. Setting: The study was carried out in the neonatal intensive
care unit (NICU). Study Duration: The duration of the study was 1 year. Material and Methods: A total of 246 preterm neonates admitted to Aga Khan University Hospital
(AKUH) neonatal intensive care unit in the tenure of 1 year, fulfilling the
inclusion criteria and requiring packed cell transfusion were included. After the
approval from ethical review committee, charts were reviewed for gestational
age, birth weight, mode of delivery (normal vaginal or Cesarean-section) were
recorded. Indications of packed cell transfusion (intraventricular hemorrhage,
infection or sepsis, anemia of prematurity, phlebotomy losses, increase oxygen
requirement, hematological causes, other causes of hemorrhage and other causes)
were observed and recorded. Pre-transfusion hemoglobin levels (g/dL) and
hematocrit levels were also recorded. Other information like number and volume
of transfusion and day of life on which transfusion was administered was also
documented. Results: A total of 246 critically ill children were enrolled
in this study. Of the total, 52.8% were baby
boys and 47.2% were baby girls. 57% of babies were born via cesarean section
and 43% were born via vaginal delivery. Out of total preterm newborns admitted
in NICU, 22.8% were extremely preterm, 35.4% were very preterm and 41.9% were
late preterm. Mean gestational age was observed to be 31 (±4) weeks and the mean
birth weight of newborns was 1500 (±600) grams. Indications
of packed cell transfusion observed in our study are intraventricular
hemorrhage 10%, 26% sepsis/infection, 4% hematological
disorders, 12.8% anemia of prematurity, 25.2% was related to increase in oxygen
requirement, 13% other hematological causes and 9.3% other causes. Conclusion: An increase in oxygen requirement and anemia of prematurity were the
indications that were observed in the extremely preterm and very preterm
groups. Sepsis and increase oxygen requirement are some of the major causes of
transfusions observed in the late preterm group. Preventable indications can be
one of the areas that can be worked on and will reduce the need for transfusion
in preterm babies with subsequent prevention of transfusion-associated risks.