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1.
Vox Sang ; 104(3): 207-13, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23046429

RESUMEN

BACKGROUND AND OBJECTIVES: Platelet transfusions are performed almost entirely according to expert experience. This study assessed the effectiveness of a restrictive guideline to reduce platelet transfusions in preterm infants. METHODS: A retrospective cohort of preterm infants with a birth weight of <1500 g had been born in 2 periods. In Period 1, a transfusion was indicated for a platelet count of <50,000/ml in clinically stable neonates or <100,000/ml in bleeding or clinically unstable infants. In Period 2, the indications were restricted to <25,000/ml in clinically stable neonates, or <50,000/ml in newborns who were either on mechanical ventilation, subject to imminent invasive procedures, within 72 h following a seizure, or extremely premature and <7 days old. A count of <100,000/ml was indicated for bleeding or major surgery. RESULTS: Periods 1 and 2 comprised 121 and 134 neonates, respectively. The rates of ventricular haemorrhage and intrahospital death were similar in both periods. The percentage of transfused infants, the odds of receiving a platelet transfusion, the mean platelet count before transfusion and the percentage of transfusions with a platelet count >50,000/ml were greater in Period 1. Among thrombocytopenic neonates, the percentage of transfused neonates and the number of transfusions were similar in both groups. CONCLUSION: The restrictive guideline for platelet transfusions reduced the platelet count thresholds for neonatal transfusions without increasing the rate of ventricular haemorrhage.


Asunto(s)
Recuento de Plaquetas/normas , Transfusión de Plaquetas/normas , Guías de Práctica Clínica como Asunto , Plaquetas , Peso Corporal , Femenino , Humanos , Recién Nacido , Recién Nacido de muy Bajo Peso , Cuidado Intensivo Neonatal/organización & administración , Masculino , Proyectos Piloto , Transfusión de Plaquetas/métodos , Respiración Artificial , Estudios Retrospectivos , Convulsiones/terapia , Factores de Tiempo
2.
Vox Sang ; 95(2): 106-11, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18544122

RESUMEN

BACKGROUND AND OBJECTIVES: Benefits of adopting restrictive guidelines for erythrocyte transfusions are still controversial. The objective of this study was to verify if a very strict guideline could reduce erythrocyte transfusions in preterm infants without adverse outcomes. MATERIALS AND METHODS: Two prospective cohorts of neonates with gestational age < 37 weeks and birth weight < 1500 g were studied. Neonates born in Period 1 were submitted to a strict guideline for erythrocyte transfusions. In Period 2, a new stricter protocol was introduced. Infants of both periods were compared regarding number of transfusions and clinical outcome. RESULTS: The median number of transfusions decreased from 2 (1 to 14) in Period 1 to 1 (1-9), P = 0.001, in Period 2. The linear regression multivariate analysis showed that the implementation of the stricter guideline was associated with a reduction in the number of transfusions received by patients by 0.55 (95% confidence interval: -0.08; -1.02) units/patients. Number of apnea episodes, weight at 28 days of life and days of hospital stay were similar in both periods. Intra-hospital death was lower in Period 2. CONCLUSION: A very strict guideline reduced the number of erythrocyte transfusions in preterm infants, without threatening their clinical course.


Asunto(s)
Transfusión de Eritrocitos/estadística & datos numéricos , Adhesión a Directriz , Enfermedades del Prematuro/terapia , Guías de Práctica Clínica como Asunto , Apnea/epidemiología , Hemorragia Cerebral/epidemiología , Estudios de Cohortes , Transfusión de Eritrocitos/normas , Femenino , Edad Gestacional , Hematócrito , Mortalidad Hospitalaria , Humanos , Hipoxia/epidemiología , Hipoxia/prevención & control , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/prevención & control , Recién Nacido Pequeño para la Edad Gestacional , Recién Nacido de muy Bajo Peso , Tiempo de Internación/estadística & datos numéricos , Masculino , Flebotomía/efectos adversos , Respiración con Presión Positiva/estadística & datos numéricos , Estudios Prospectivos
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