Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

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Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Fuchs A.
  • Disma N.
  • Virág K.
  • Ulmer F.
  • Habre W.
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Grupos

Abstract

BACKGROUND Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (=week 3) onwards. OBJECTIVE To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN A multicentre observational study. SETTING The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing perioperative red blood cell transfusions strategies. Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

Datos de la publicación

ISSN/ISSNe:
0265-0215, 1365-2346

EUROPEAN JOURNAL OF ANAESTHESIOLOGY  LIPPINCOTT WILLIAMS & WILKINS

Tipo:
Article
Páginas:
252-2560
PubMed:
34845167
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
0,979 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Anesthesia; Erythrocyte Transfusion; Europe; Hemoglobins; Humans; Infant, Newborn; Prospective Studies; hemoglobin; hemoglobin; anemia; Article; child; childhood mortality; cohort analysis; controlled study; cyanotic heart disease; erythrocyte transfusion; female; follow up; heart catheterization; hemoglobin blood level; human; infant; infant care; major clinical study; male; mortality rate; multicenter study; newborn; newborn care; observational study; perioperative medicine; practice guideline; treatment outcome; adverse event; anesthesia; clinical trial; Europe; prospective study

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