BackgroundPreterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current... Show moreBackgroundPreterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data. MethodsFrom October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of ResultsResponses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25x10(9)/L in non-bleeding infants of GA of <28 weeks, while the 25x10(9)/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs. ConclusionsTransfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice. Show less
Beek, P.E. van; Rijken, M.; Broeders, L.; Horst, H.J. ter; Koopman-Esseboom, C.; Kort, E. de; ... ; EPI-DAF Study Grp 2022
Objective In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide... Show moreObjective In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study. Patients All live born infants between 24(0/7) weeks' and 26(6/7) weeks' gestational age who were 2 years' CA in 2018-2020. Main outcome measure Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function. Results 651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively. Conclusions Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.In a Dutch national cohort of infants born 24+0 to 26+6/7 weeks gestation born after changes to guidelines supporting active treatment at 24+0 weeks, the majority did not have neurodevelopmental impairment at 2-year follow up as defined in this study. Show less
The case history is based on the health experiences of a boy in the first years of his life. The author aims to shed some light on one of the crucial medical problems of the Third World: the... Show moreThe case history is based on the health experiences of a boy in the first years of his life. The author aims to shed some light on one of the crucial medical problems of the Third World: the interplay between cosmopolitan (i.e. western, modern) medicine, and such other forms of medicine as exist locally. He argues that the health behaviour of the people involved in the case are rational and understandable. In a postscript (pp. 87-90) he explains his position on the role of cognition more fully. Show less
