Platelet transfusions in neonates: practices in the United States vary significantly from those in Austria, Germany, and Switzerland
Platelet transfusions in neonates: practices in the United States vary significantly from those in Austria, Germany, and Switzerland
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DOI：
10.1111/j.1537-2995.2011.03208.x
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发表时间：
2011-12-01
期刊：
影响因子：
2.9
通讯作者：
Dame, Christof
中科院分区：
文献类型：
--
作者：
Cremer, Malte;Sola-Visner, Martha;Dame, Christof
背景：在入住新生儿重症监护病房(NICU)的患者中，有20%到35%的患者会受到血小板减少的影响。血小板(PLT)输注通常比年龄较大的儿童或成人使用的阈值更高，尽管缺乏指导这些决定的证据。STUDY设计和方法：在这项研究中，我们使用基于网络的调查，调查了三个欧洲国家(奥地利、德国和瑞士[AUT/GER/SUI])1级NICU(相当于美国的3级)中使用的PLT输注阈值。这项调查与之前发给美国新生儿医生的调查完全相同，因此可以直接比较他们对11种基于病例的情景的反应。结果：在9种情景中，澳大利亚大学新生儿科医生选择的血小板输注阈值比美国新生儿医生低得多(p<；0.0001)。治疗新生儿同种免疫性血小板减少症时和侵入性手术前的输血阈值更为相似。这些差异的临床影响是通过外推AUT/GER/SUI与美国对出生体重低于1000 g的新生儿队列的回答来估计的。这表明，在AUT/GER/SUI中，这些新生儿每1000名婴儿将接受167次PLT输血，而美国为299次PLT输血。结论：这项关于新生儿PLT输注实践的首次国际比较调查显示，美国的输血阈值明显高于AUT/GER/SUI。需要设计良好的临床研究来解决这些不同方法的风险和/或好处。
BACKGROUND: Thrombocytopenia affects 20% to 35% of patients admitted to neonatal intensive care units (NICUs). Platelet (PLT) transfusions are usually administered to neonates with thrombocytopenia at higher thresholds than those used for older children or adults, although there is a paucity of evidence to guide these decisions.STUDY DESIGN AND METHODS: In this study, we used a Web-based survey to investigate the PLT transfusion thresholds used in Level 1 NICUs (equivalent to Level 3 in the US) in three European countries (Austria, Germany, and Switzerland [AUT/GER/SUI]). This survey was identical to the one that was previously sent to US neonatologists, thus allowing for a direct comparison of their responses to 11 case-based scenarios.RESULTS: In nine of the scenarios, AUT/GER/SUI neonatologists selected substantially lower PLT transfusion thresholds than US neonatologists (p < 0.0001). Transfusion thresholds were more similar when treating neonatal alloimmune thrombocytopenia and before invasive procedures. The clinical impact of these differences was estimated by extrapolating the AUT/GER/SUI versus the US answers to a cohort of neonates with a birth weight below 1000 g. This suggested that, in AUT/GER/SUI, these neonates would receive 167 PLT transfusions per 1000 infants, compared to 299 PLT transfusions in the United States.CONCLUSION: This first international comparative survey on PLT transfusion practice in neonates reveals substantially higher transfusion thresholds in the United States than in AUT/GER/SUI. Well-designed clinical studies are needed to address the risks and/or benefits of these different approaches.