Reducing incidence of red cell transfusion among preterm babies in a tertiary care neonatal intensive care unit: A retrospective observational study

Abstract

Background: Preterm neonates in the neonatal intensive care unit (NICU) receive a greater number of red cell transfusions (RCTs) than any other hospitalized group. Iatrogenic anemia, secondary to blood draws, increases the need for transfusions in preterm neonates. Blood transfusions are related to transfusion reactions and risk of transmitting infection. Objective: This retrospective study was done to find the incidence of RCT in neonates born less than or at 32+0 weeks of gestation and to establish whether requirement of blood transfusions could be further decreased. Methodology: A retrospective study of all intramural births less than or at 32+0 weeks of gestation who were admitted and discharged from the NICU of Fortis La Femme, GK-II, New Delhi, from February 1, 2017, to January 31, 2018, was done, and the data were analyzed by statistical software IBM SPSS Statistics for Windows, Version 21.0. Results: Forty-three babies were studied, of which 16 were female. The mean gestation age was 29.49 ± 2.35 weeks, and the mean birth weight was 1234.93 ± 368.737 grams. Seventeen (39.5%) neonates required RCT during their hospital stay, of which 11 (64.7%), 2 (11.7%), 3 (17.6%), and 1 (5.8%) neonate received 1, 2, 3, and 6 unit of RCT, respectively. The incidence of RCT was significantly higher in babies with sepsis and babies who received surfactant. RCTs were observed to be significantly higher in babies who were managed with invasive methods such as mechanical ventilation and use of peripherally inserted central catheter/central lines for administration of total parenteral nutrition. The number of RCTs required also correlated with the number of ventilated days and days on continuous positive airway pressure. Conclusion: Majority of the neonates born less than or at 32+0 weeks can be managed without the requirement of RCT. A restrictive blood transfusion policy, judicious use of blood investigation, use of microsampling and point of care investigations such as capillary blood gas, early initiation of enteral feeds and iron supplementation, prevention of sepsis, judicious use of venous/arterial lines and noninvasive management protocols has helped reduce blood transfusion in preterm neonates.