Neonatal Anemia in Preterm Infants: Are We Overtransfusing?
Bibliographic record
Abstract
AIMS AND OBJECTIVES: The purpose of this study was to ascertain the appropriate packed red blood cell transfusion (PRBCT) practice for preterm infants consistent with multiple international guidelines. METHOD: This retrospective study was conducted at a tertiary care center in India from February 2019 to December 2020. All preterm neonates born at <32 weeks of gestation who received PRBCTs during the study period were included. The hemoglobin (Hb) levels at the time of transfusion were analyzed to assess adherence to the transfusion thresholds recommended by the British Committee for Standards in Haematology (BCSH), Canadian Blood Services (CBS), and the Australian National Blood Authority (ANBA), considering postnatal age and the need for respiratory support. RESULTS: A total of 43 preterm neonates (gestational age, 28.08±1.08 weeks; birth weight, 1,018±0.027 g) received 78 PRBCTs. Specifically, nine (11.5%) PRBCTs were given in the first week, 14 (18%) in the second week, and 55 (70.5%) at three or more weeks of age. Further, nine (11.5%) PRBCTs were given during mechanical ventilation (MV), 49 (63%) with non-invasive ventilation (NIV) or oxygen (O₂) support, and 20 (25.5%) without O₂ support. The appropriateness of all of the PRBCTs per the BCSH, CBS, and ANBA guidelines was 63/78 (80.7%), 58/78 (74.3%), and 78/78 (100%), respectively. Most of the neonates on respiratory support received PRBCTs in a manner consistent with the CBS, BCSH, and ANBA guidelines, whereas most of the neonates not on oxygen (O₂) therapy received PRBCTs for late anemia (at three weeks or more of age) at a higher Hb level than that suggested by the CBS and BCSH guidelines but consistent with the ANBA guidelines. CONCLUSION: In this transfusion audit study, liberal PRBCT practice was observed for late anemia among stable preterm infants, consistent with the CBS and BCSH blood transfusion guidelines. Hence, there is room for improvement in PRBCT policies in terms of quality-improvement interventions to prevent over-transfusion.
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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 | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".