64: Epidemiology and Determinants of Transfusions of Red Blood Cells, Plasma and Platelet Concentrates in a Neonatal Intensive Care Unit (NICU): A Single Center Cohort Study
Bibliographic record
Abstract
Blood product transfusions are common in NICU, but transfusion practices are not well described. To describe the incidence and determinants of red blood cells (RBC), plasma and platelets transfusions in our NICU. Single-center prospective observational cohort study. All neonates admitted to the NICU of CHU Sainte-Justine Hospital (level 3B) from May 30 to August 6 2013 were included. Daily data were extracted from medical charts using a validated case report form up to 44 weeks post conception or discharge. Clinician's justifications for transfusion were assessed using a questionnaire. All 152 patients admitted in the NICU during the study period were included. Mean (± SD) birth weight (BW) and gestational age (GA) were 2.41±1 kg and 34.4±4.3 weeks. At least one RBC, plasma or/and platelets transfusion was given in 19 (12.5%) patients. RBC, plasma and platelets were transfused to 16 (10.5%), seven (4.6%) and seven (4.6%) patients respectively. Six (37.5%) of the RBC, three (43%) of the plasma and four (57%) of the platelets transfused patients received single transfusion. Donor exposure was restricted to only one in 14 (87%) of RBC, in four (57%) of plasma and in five (71%) of platelets recipients. Compared to non transfused patients, those who received at least one blood product transfusion had a significantly lower platelets level on the cord sample (172×109/L vs 236×109/L; P=0.01). Sex, GA, BW, cord hemoglobin (Hb) were comparable among both groups. Transfused patients were more frequently admitted for suspected bacterial infection (P=0.01) and hypoxic-ischemic encephalopathy (HIE) (P<0.001). At admission, neonates with higher SNAPPE-II score (P<0.001), on high frequency ventilation (HFV) (P<0.001) and with lower Hb (138 g/L vs 175 g/L; P<0.001) were more likely to receive transfusion during their NICU stay. Most frequently quoted justifications for RBC transfusions were repectively 1 – low Hb level, 2 – intent to improve oxygen delivery and 3 – severity of the illness. In this study, transfusions were not as frequent as expected. Lower platelets count on the cord sample and admission for bacterial infection or HIE are associated with transfusions in NICU patients. A higher SNAPPE-II score, HFV and lower Hb at admission in NICU are significant determinants for later RBC, plasma and/or platelets transfusions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".