676 - International variations in transfusion practices in 12 countries or regions

Publication Number: 676.5338

Gil Klinger, Schneider Children's Medical Center of Israel and Tel Aviv University, Ramat Hasharon, HaMerkaz, Israel; Kjell Helenius, University of Turku, Turku, Varsinais-Suomi, Finland; Maximo Vento, Instituto de Investigación Sanitaria La Fe, VALENCIA, Comunidad Valenciana, Spain; Satoshi Kusuda, Kyorin University, Taito, Tokyo, Japan; Mikael Norman, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden; Renato S. Procianoy, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Neha Goswami, Mount Sinai Hospital, Toronto, ON, Canada; Valerie Biran, Robert Debre Children's Hospital, Assistance Publique Hôpitaux de Paris,University Paris-Cité, INSERM U1141, France, Paris, Ile-de-France, France; Dirk Bassler, University Hospital of Zurich, Zurich, Zurich, Switzerland; Brian Reichman, Sheba Medical Center, Ramat Gan, HaMerkaz, Israel; Aleksandra Skubisz, Neonatal and Intensive Care Department, Rzeszów Provincial Hospital No. 2, 35-055 Rzeszów, Poland, Rzeszów, Podkarpackie, Poland; Malcolm Battin, Auckland City Hospitial, Auckland, Auckland, New Zealand; Liisa Lehtonen, University of Turku, Turku, Varsinais-Suomi, Finland; Kei Lui, University of New South Wales, Sydney, New South Wales, Australia; Annalisa Mori, Azienda Ospedaliera Universitaria Senese, Siena, Toscana, Italy; Mark Adams, University Hospital Zurich, Zurich, Zurich, Switzerland; Laura San Feliciano, Hospital Universitario de Salamanca, Salamanca, Castilla y Leon, Spain; Tetsuya Isayama, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada

Background: Blood transfusions are commonly used in the neonatal intensive care setting. Most countries do not have national guidelines for neonatal transfusions. In recent years, a stricter approach aimed to decrease blood transfusions has been adopted by many neonatal intensive care units (NICU’s).

Objective: To survey the variations in blood transfusion practises in preterm neonates of < 29 weeks’ gestation among neonatal units of 12 population-based national or regional neonatal networks participating in the International Network for Evaluating Outcomes in Neonates (iNeo).

Design/Methods: Online pre-piloted questionnaires were sent to the directors or representatives of 608 NICU’s participating in Australia/New-Zealand (ANZNN n= 30), Brazil (BNN=20), Canada (CNN, n=32), Finland (FinMBR, n=5), France (FR, n=70), Israel (INN, n=26), Japan (NRNJ, n=292), Poland (PL, n=56), Spain (SEN1500, n=55), Sweden (SNQ, n=9), Switzerland (SNN, n=9), and Tuscany, Italy (TuscanNN, n=4). The responses were based on practices in 2023. Two reminders were sent. Four different scenarios were given to assess the effect of the infants age and respiratory support on hematocrit threshold for blood transfusion: Infants invasively ventilated within first 7 days of life, infants invasively ventilated after 7 days, stable infants on non-invasive respiratory support and stable infants requiring no respiratory support.

Results: Overall, 382 NICU’s (63%) responded. The responses ranged from 37-100% among participating networks. Table 1 describes the characteristics of participating NICU’s. Transfusion practices varied widely both within networks and between countries (Table 2). In the first 7 days of life, most NICU’s (61%) chose to keep the hematocrit at a level of 35% or above. Invasively ventilated infants (age > 7 days) were kept by most NICU’s (79%) at a hematocrit of 30% or above. A low hematocrit of 25% was allowed by 68% of NICU’s before requiring a blood transfusion for stable non-ventilated infants.

Conclusion(s): There were marked variations in blood transfusion practises of very preterm infants between countries and within networks. Despite the observed variation, for each clinical scenario there was agreement on transfusion practice by 50% or more of NICU’s, with a greater degree of agreement in stable infants without respiratory support. Further collaboration is needed to better understand the association of these variations in practice with variations in rates of neonatal outcomes across different countries and units.

Table 1 – Characteristics of participating Neonatal Intensive Care Units


Table 2 – Transfusion thresholds in various clinical scenarios by Neonatal Network