Effect of Minimization of Early Blood Sampling Losses Among Extremely Premature Neonates: A Randomized Clinical Trial

Abstract

To evaluate the effect of blood sampling stewardship on transfusion requirements among infants born extremely preterm. In this single-center, randomized controlled trial, infants born at <28 weeks of gestation and birth weight of <1000 g were randomized at 24 hours of age to two different blood sampling approaches: restricted sampling versus conventional sampling. The stewardship intervention in the restricted sampling group included targeted reduction in blood sampling volume and frequency and point of care testing methods in the first six weeks after birth. Both groups received early recombinant erythropoietin from day three of age. Primary outcome was the rate of early red blood cell (RBC) transfusions in the first six postnatal weeks. A total of 102 infants (mean gestational age: 26 weeks; birth weight: 756 g) were enrolled. Fidelity to the sampling protocol was achieved in 95% of the infants. Sampling losses in the first six weeks were significantly lower in the restricted sampling group (16.8 ml/kg vs 23.6 ml/kg, P<0.001). The restricted sampling group had a significantly lower rate of early postnatal RBC transfusion (41% versus 73%, RR: 0.56 [0.39-0.81], P=0.001). The hazard of needing a transfusion during NICU stay was reduced by 55% by restricted sampling. Mortality and neonatal morbidities were similar between the two groups. Minimization of blood sampling losses by approximately one third in the first six weeks after birth leads to substantial reduction in the early RBC transfusion rate in infants born extremely preterm who weighed <1000 g at birth. http://www.ctri.nic.in (CTRI/2020/01/022964).