ABSTRACT
OBJECTIVE: To study patterns of use of Fresh Frozen Plasma (FFP) and Cryoprecipitate (CRYO) in a level 4 NICU and assess what proportions were not supported by literature. STUDY DESIGN: single centered retrospective observational. Charts of neonates admitted between 1/1/2010 to 12/31/2017 to CT Children's level 4 NICU were reviewed. Transfusions were assigned as "supported" or "non-supported" based on available evidence. Groups were compared using T-tests and chi-squared analyses. RESULTS: of 4110 total admissions, 197 (4.8%) received a total of 461 transfusions (374 FFP, 87 CRYO). Only 59% of FFP and 60% CRYO were supported by literature. Within the "non-supported" group the largest category was neonates transfused prophylactically. CONCLUSION: A large proportion of transfusions administered to neonates was not evidence-based, suggesting there are opportunities for improvement in use of these products.
Subject(s)
Intensive Care Units, Neonatal , Plasma , Humans , Infant, Newborn , Blood Component Transfusion , Retrospective StudiesABSTRACT
Neonatal polycythemia and hyperviscosity are defined as a hematocrit > or =65% and a viscosity value >2 standard deviations greater than the norm. Although polycythemia can reflect normal fetal adaptation, it has been thought to be responsible for abnormalities in the neonate. Polycythemia and hyperviscosity are associated with blood-flow changes in some organs, which alter their function. Partial exchange transfusion (PET) has been used to treat both symptomatic and asymptomatic patients. At present, no data support the use of PET in asymptomatic infants; the potential benefit in symptomatic infants depends on the symptoms. Studies of long-term neurodevelopmental status do not show any clear long-term benefits for PET. Crystalloids are as effective as colloids in PET and have the advantage of being cheaper and more readily available; also, they do not confer any risk of infection or anaphylaxis.
Subject(s)
Blood Viscosity/physiology , Polycythemia/physiopathology , Colloids , Exchange Transfusion, Whole Blood/methods , Humans , Infant, Newborn , Isotonic Solutions , Polycythemia/diagnosis , Polycythemia/etiology , Polycythemia/therapyABSTRACT
BACKGROUND: Infants of diabetic mothers (IDMs) are at an increased risk for thromboembolic disease. The mechanism(s) to explain this association is unclear. We hypothesized that the pathophysiology of thrombosis in IDMs is multifactorial and likely involves interactions among genetic and acquired factors affecting the procoagulant, anticoagulant and fibrinolytic pathways. OBJECTIVE: To compare the prevalence of common prothrombotic risk factors in a cohort of IDMs to a matched control group. PATIENTS/METHODS: Full-term infants born to mothers with diet controlled (A1-IDM) (N=17), insulin requiring diabetes (ID-IDM) (N=20) and healthy term infants (controls) (N=20) matched for mode of delivery had cord blood collected at delivery. Samples were analyzed for the following: factor V Leiden (FVL), prothrombin 20210A (P20210A), methylenetetrahydrofolate reductase C677 T (MTHFR), Factor VIII (FVIII), Protein C (PC), Lipoprotein(a) (Lp(a)) and plasminogen activator inhibitor-1 (PAI-1). RESULTS: None of the infants had a clinically apparent thrombotic event. IDM mothers and their infants were clinically similar to controls except for a higher prevalence of hypoglycemia (30 vs 0%; p=0.005). There was no significant difference in the prevalence of the common genetic risk factors (FVL, P20210A, MTHFR) FVIII, or PAI-1 levels. Elevated Lp(a) levels were seen more frequently in IDMs than Controls (40 vs 20%) but this difference was not statistically significant. The PC activity (%) was significantly decreased in the IDM group compared to controls, 35+/-12 vs 44+/-9 (p<0.005). A1-IDM had lower PC activity compared to ID-IDM (p=0.05) and controls (p=0.001). CONCLUSIONS: PC deficiency is likely one mechanism to explain thrombosis in IDMs.
Subject(s)
Diabetes Mellitus, Type 1/blood , Diabetes, Gestational/blood , Fetal Blood/chemistry , Pregnancy in Diabetics/blood , Blood Coagulation Factors/analysis , Case-Control Studies , Cohort Studies , Female , Humans , Infant, Newborn , Lipoprotein(a)/blood , Methylenetetrahydrofolate Reductase (NADPH2)/blood , Pregnancy , Protein C/analysis , Risk Factors , Thrombosis/etiologyABSTRACT
Fibrin glue was used to treat significant pneumothoraces persisting for an average of 10 days in eight newborns. Six of the eight infants had reduction or resolution of persistent air leak within 24 hours of therapy. Two infants received a second course of therapy for recurrences. Complications encountered were bradycardia requiring manual ventilation (N=2), significant hypercalcemia (N=2), diaphragmatic paralysis (N=2), pneumothorax (PTX) on the contralateral side (N=1), and localized tissue necrosis (N=1). Fibrin glue is an effective treatment for intractable PTX but has significant risks.
