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Valete COS, Angelica Luiz Ferreira E, Montenegro CP, Pilati MCA, Rodrigues Wilde MOD, Witkowski SM. Frequency of red blood cell transfusions in preterm neonates in Brazil: A systematic review and meta-analysis. Vox Sang 2024; 119:8-15. [PMID: 37920102 DOI: 10.1111/vox.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/11/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Red blood cell transfusions are frequent in preterm neonates. The proportion of preterm neonates transfused in Brazil remains unknown. We systematically reviewed the literature to estimate the frequency of red blood cell transfusions in preterm neonates in Brazil. MATERIALS AND METHODS The LILACS, EMBASE, Cochrane, SciELO, MEDLINE (PubMed), Web of Science, Scopus, BDTD and 27 national university institutional databases were searched for studies that analysed red blood cell transfusion in preterm neonates in Brazil without period restriction. The Preferred Reporting Items in Systematic Reviews and Meta-Analyses guidelines were followed, and the GRADE methodology was applied. A random-effects model along with the restricted maximum likelihood method was used, and the Freeman-Tukey transformed proportion was used to estimate effect size. RESULTS Nine studies, representing 6548 preterm neonates, were included in the qualitative and quantitative analyses. The mean gestational age ranged from 26.0 to 31.6 weeks. Most of the studies were from the Southeast region. The pooled estimated frequency of red blood cell transfusions was 58.0% (95% confidence interval = 52.0%-64.0%, p < 0.001) with low certainty. There was statistically significant heterogeneity among studies (I2 = 92.5%, p < 0.001). CONCLUSION In this current meta-analysis of the evidence available, which included moderate and extremely preterm neonates, the observed frequency of red blood cell transfusions in preterm neonates in Brazil was 58.0% and this estimate can help health programming. Some Brazilian regions were not included in this study, and further research is needed to provide a more representative overview of Brazil.
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Affiliation(s)
| | | | - Carolina Perez Montenegro
- Medicine Department (DMed), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Maria Clara Alves Pilati
- Medicine Department (DMed), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | | | - Sandra Mara Witkowski
- Department of Pediatrics, University of Vale do Itajaí, Itajaí, Santa Catarina, Brazil
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Puia-Dumitrescu M, Tanaka DT, Spears TG, Daniel CJ, Kumar KR, Athavale K, Juul SE, Smith PB. Patterns of phlebotomy blood loss and transfusions in extremely low birth weight infants. J Perinatol 2019; 39:1670-1675. [PMID: 31582812 PMCID: PMC7331095 DOI: 10.1038/s41372-019-0515-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/25/2019] [Accepted: 08/13/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Characterize frequency and volume of blood draws and transfusions in extremely low birth weight infants in the first 10 weeks of life. STUDY DESIGN We included infants with a birth weight <1000 g born 23 0/7-29 6/7 weeks gestational age (GA) and with a length of stay ≥10 weeks, admitted between 2014 and 2016 to a single neonatal intensive care unit. RESULTS Of 54 infants, median (25th, 75th percentile) GA and birth weight were 25 weeks (24, 26) and 665 g (587, 822), respectively. Median number of blood draws per infant decreased from 57 (49, 65) in week 1 to 12 (8, 22) in week 10. Median volume of blood extracted was 83 mL (70, 97), and median number of blood transfusions was 8 (5, 10). CONCLUSIONS This cohort experienced a high number and volume of blood draws. Draw frequency and transfusions decreased over the first 10 weeks of life.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington, Seattle, WA, USA,Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - David T. Tanaka
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | | | | | - Karan R. Kumar
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA,Duke Clinical Research Institute, Durham, NC, USA
| | - Kamlesh Athavale
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Sandra E. Juul
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - P. Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA,Duke Clinical Research Institute, Durham, NC, USA
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Boehm R, Cohen C, Pulcinelli R, Caletti G, Balsan A, Nascimento S, Rocha R, Calderon E, Saint’Pierre T, Garcia S, Sekine L, Onsten T, Gioda A, Gomez R. Toxic elements in packed red blood cells from smoker donors: a risk for paediatric transfusion? Vox Sang 2019; 114:808-815. [DOI: 10.1111/vox.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/22/2019] [Accepted: 09/14/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Renata Boehm
- Programa de Pós‐Graduação em Farmacologia e Terapêutica Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Serviço de Hemoterapia do Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil
| | - Carolina Cohen
- Serviço de Hemoterapia do Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil
| | - Rianne Pulcinelli
- Programa de Pós‐Graduação em Farmacologia e Terapêutica Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
| | - Greice Caletti
- Programa de Pós‐Graduação em Farmacologia e Terapêutica Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
| | - Almeri Balsan
- Serviço de Hemoterapia do Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil
| | - Sabrina Nascimento
- Laboratório de Toxicologia (LATOX) Departamento de Análises Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
| | - Rafael Rocha
- Departamento de Química Pontifícia Universidade Católica do Rio de Janeiro (PUC‐ Rio) Rio de Janeiro Brazil
| | - Enrique Calderon
- Departamento de Química Pontifícia Universidade Católica do Rio de Janeiro (PUC‐ Rio) Rio de Janeiro Brazil
| | - Tatiana Saint’Pierre
- Departamento de Química Pontifícia Universidade Católica do Rio de Janeiro (PUC‐ Rio) Rio de Janeiro Brazil
| | - Solange Garcia
- Laboratório de Toxicologia (LATOX) Departamento de Análises Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
| | - Leo Sekine
- Serviço de Hemoterapia do Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil
| | - Tor Onsten
- Serviço de Hemoterapia do Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil
| | - Adriana Gioda
- Departamento de Química Pontifícia Universidade Católica do Rio de Janeiro (PUC‐ Rio) Rio de Janeiro Brazil
| | - Rosane Gomez
- Programa de Pós‐Graduação em Farmacologia e Terapêutica Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
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Lemyre B, Sample M, Lacaze-Masmonteil T. Minimizing blood loss and the need for transfusions in very premature infants. Paediatr Child Health 2016; 20:451-62. [PMID: 26744559 DOI: 10.1093/pch/20.8.451] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reducing blood loss and the need for blood transfusions in extremely preterm infants is part of effective care. Delayed cord clamping is well supported by the evidence and is recommended for infants who do not immediately require resuscitation. Cord milking may be an alternative to delayed cord clamping; however, more research is needed to support its use. In view of concerns regarding the increased risk for cognitive delay, clinicians should avoid using hemoglobin transfusion thresholds lower than those tested in clinical trials. Higher transfusion volumes (15 mL/kg to 20 mL/kg) may decrease exposure to multiple donors. Erythropoietin is not recommended for routine use due to concerns about retinopathy of prematurity. Elemental iron supplementation (2 mg/kg/day to 3 mg/kg/day once full oral feeds are achieved) is recommended to prevent later iron deficiency anemia. Noninvasive monitoring (eg, for carbon dioxide, bilirubin) and point-of-care testing reduce the need for blood sampling. Clinicians should strive to order the minimal amount of blood sampling required for safe patient care, and cluster samplings to avoid unnecessary skin breaks.
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Lemyre B, Sample M, Lacaze-Masmonteil T. Limiter les pertes de sang et le recours aux transfusions chez les grands prématurés. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.8.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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dos Santos AMN, Guinsburg R, de Almeida MFB, Procianoy RS, Marba STM, Ferri WAG, Rugolo LMDS, Lopes JMA, Moreira MEL, Luz JH, González MRC, Meneses JDA, da Silva RVC, Abdallah VOS, Duarte JLMB, Marques PF, Rego MAS, Alves Filho N, Krebs VLJ. Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units. BMC Pediatr 2015; 15:113. [PMID: 26341125 PMCID: PMC4560891 DOI: 10.1186/s12887-015-0432-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/21/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. METHODS A prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. RESULTS A total of 2208 (51.6%) infants received RBC transfusions (variation per neonatal unit: 34.1% to 66.4%). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. CONCLUSIONS The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.
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Affiliation(s)
| | - Ruth Guinsburg
- Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | | | - José Maria Andrade Lopes
- Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira - Fundação Oswaldo Cruz, Avenida Rui Barbosa, 716, Rio de Janeiro, RJ, CEP 22420040, Brazil.
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira - Fundação Oswaldo Cruz, Avenida Rui Barbosa, 716, Rio de Janeiro, RJ, CEP 22420040, Brazil.
| | - Jorge Hecker Luz
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Uezima CL, Barreto AM, Guinsburg R, Chiba AK, Bordin JO, Barros MMO, dos Santos AMN. Reduction of exposure to blood donors in preterm infants submitted to red blood cell transfusions using pediatric satellite packs. REVISTA PAULISTA DE PEDIATRIA 2014; 31:285-92. [PMID: 24142309 PMCID: PMC4182979 DOI: 10.1590/s0103-05822013000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/22/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS A prospective study was conducted with preterm infants with birth weight <1000 g (Group 1) and 1000-1499 g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000 g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000 g.
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dos Santos AMN. Comment on: Transfusion practices in a neonatal intensive care unit in a Brazilian town. Rev Bras Hematol Hemoter 2014; 36:241-2. [PMID: 25031160 PMCID: PMC4207921 DOI: 10.1016/j.bjhh.2014.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Radicioni M, Troiani S, Mezzetti D. Functional echocardiographic assessment of myocardial performance in anemic premature infants: a pilot study. Pediatr Cardiol 2012; 33:554-61. [PMID: 22274640 DOI: 10.1007/s00246-012-0154-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
This prospective observational study conducted in a neonatal intensive care unit aimed to evaluate echocardiographic changes provoked by anemia and transfusion of packed red blood cells (pRBCs) in premature infants. In this study, 32 anemic premature infants had serial echocardiographic assessment of left ventricular (LV) systolic performance, LV preload, and afterload immediately before, within 48 h, and up to 120 h after the transfusion of pRBCs. Pretransfusional evaluations also were compared with similar assessments of 71 nonanemic inpatient premature infants analogous for sex, gestational age at birth, and postnatal age. Left ventricular systolic performance was estimated from fractional shortening, LV output, and LV myocardial performance index (LVMPI). The LV preload was estimated from the LV end-diastolic dimension and the ratio of left atrium-to-aortic root dimension (LA/Ao ratio). The LV afterload was estimated from end-systolic wall stress. The LVMPI was found to decrease with increasing corrected gestational age in both the nonanemic (R = 0.173; p = 0.03) and anemic (R = 0.460; p = 0.007) infants. The LVMPI was the only index that changed after transfusion of pRBCs, decreasing in the younger anemic infants (p = 0.011) and increasing in the older anemic infants (p = 0.012). Finally, a significant inverse relationship between pre- and posttransfusional LVMPI values (R = 0.730; p < 0.001) was noted. The LVMPI may allow for identification of preterm infants more likely to be helped by transfusion of pRBCs.
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Affiliation(s)
- Maurizio Radicioni
- Neonatal Intensive Care Unit, S. Maria della Misericordia Hospital of Perugia, Azienda Ospedaliera di Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy.
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Whyte R, Kirpalani H. Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. Cochrane Database Syst Rev 2011:CD000512. [PMID: 22071798 DOI: 10.1002/14651858.cd000512.pub2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Infants of very low birth weight often receive multiple transfusions of red blood cells, usually in response to predetermined haemoglobin or haematocrit thresholds. In the absence of better indices, haemoglobin levels are imperfect but necessary guides to the need for transfusion. Chronic anaemia in premature infants may, if severe, cause apnoea, poor neurodevelopmental outcomes or poor weight gain.On the other hand, red blood cell transfusion may result in transmission of infections, circulatory or iron overload, or dysfunctional oxygen carriage and delivery. OBJECTIVES To determine if erythrocyte transfusion administered to maintain low as compared to high haemoglobin thresholds reduces mortality or morbidity in very low birth weight infants enrolled within three days of birth. SEARCH METHODS Two review authors independently searched the Cochrane Central Register of Controlled Trials (The Cochrane Library) , MEDLINE,EMBASE, and conference proceedings through June 2010. SELECTION CRITERIA We selected randomised controlled trials (RCTs) comparing the effects of early versus late, or restrictive versus liberal erythrocyte transfusion regimes in low birth weight infants applied within three days of birth, with mortality or major morbidity as outcomes.
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MESH Headings
- Anemia, Neonatal/blood
- Anemia, Neonatal/prevention & control
- Biomarkers/blood
- Blood Transfusion/standards
- Erythrocyte Transfusion/standards
- Hematocrit/standards
- Hemoglobin A/analysis
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/prevention & control
- Infant, Very Low Birth Weight/blood
- Morbidity
- Randomized Controlled Trials as Topic
- Reference Values
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Affiliation(s)
- Robin Whyte
- Department of Neonatal Pediatrics, IWK Health Centre - G2216, Halifax, Canada.
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dos Santos AMN, Guinsburg R, de Almeida MFB, Procianoy RS, Leone CR, Marba STM, Rugolo LMSDS, Fiori HH, Lopes JMDA, Martinez FE. Red blood cell transfusions are independently associated with intra-hospital mortality in very low birth weight preterm infants. J Pediatr 2011; 159:371-376.e1-3. [PMID: 21489555 DOI: 10.1016/j.jpeds.2011.02.040] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 01/04/2011] [Accepted: 02/28/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test the hypothesis that red blood cell (RBC) transfusions in preterm infants are associated with increased intra-hospital mortality. STUDY DESIGN Variables associated with death were studied with Cox regression analysis in a prospective cohort of preterm infants with birth weight <1500 g in the Brazilian Network on Neonatal Research. Intra-hospital death and death after 28 days of life were analyzed as dependent variables. Independent variables were infant demographic and clinical characteristics and RBC transfusions. RESULTS Of 1077 infants, 574 (53.3%) received at least one RBC transfusion during the hospital stay. The mean number of transfusions per infant was 3.3 ± 3.4, with 2.1 ± 2.1 in the first 28 days of life. Intra-hospital death occurred in 299 neonates (27.8%), and 60 infants (5.6%) died after 28 days of life. After adjusting for confounders, the relative risk of death during hospital stay was 1.49 in infants who received at least one RBC transfusion in the first 28 days of life, compared with infants who did not receive a transfusion. The risk of death after 28 days of life was 1.89 times higher in infants who received more than two RBC transfusions during their hospital stay, compared with infants who received one or two transfusions. CONCLUSION Transfusion was associated with increased death, and transfusion guidelines should consider risks and benefits of transfusion.
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Baer VL, Lambert DK, Henry E, Snow GL, Butler A, Christensen RD. Among very-low-birth-weight neonates is red blood cell transfusion an independent risk factor for subsequently developing a severe intraventricular hemorrhage? Transfusion 2010; 51:1170-8. [DOI: 10.1111/j.1537-2995.2010.02980.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Khodabux CM, van Beckhoven JM, Scharenberg JGM, El Barjiji F, Slot MC, Brand A. Processing cord blood from premature infants into autologous red-blood-cell products for transfusion. Vox Sang 2010; 100:367-73. [DOI: 10.1111/j.1423-0410.2010.01440.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baer VL, Henry E, Lambert DK, Stoddard RA, Wiedmeier SE, Eggert LD, Ilstrup S, Christensen RD. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate: a pre-post analysis within a multihospital health care system. Transfusion 2010; 51:264-9. [DOI: 10.1111/j.1537-2995.2010.02823.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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dos Santos AM, Guinsburg R, Procianoy RS, Sadeck LÃDSR, Netto AA, Rugolo LM, Luz JH, Bomfim O, Martinez FE, de Almeida MFB. Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units. Transfusion 2010; 50:150-9. [DOI: 10.1111/j.1537-2995.2009.02373.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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