Scientific article
Open access

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe

ContributorsFuchs, Alexanderorcid; Disma, Nicola; Virág, Katalin; Ulmer, Francis; Habre, Walid; de Graaff, Jurgen C.; Riva, Thomas; NECTARINE Group of the European Society of Anaesthesiology and Intensive Care Clinical Trial Network
CollaboratorsPichon, Isabelle; Vutskits, Laszlo
Published inEuropean journal of anaesthesiology, vol. 39, no. 3, p. 252-260
Publication date2022-03

Background: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards.

Objective: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome.

Design: A multicentre observational study.

Setting: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017.

Patients: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion.

Main outcome measures: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality.

Results: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%.

Conclusions: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies.

Trial registration: ClinicalTrials.gov, identifier: NCT02350348.

  • Anesthesia / adverse effects
  • Erythrocyte Transfusion
  • Europe
  • Hemoglobins / analysis
  • Humans
  • Infant, Newborn
  • Prospective Studies
Citation (ISO format)
FUCHS, Alexander et al. Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe. In: European journal of anaesthesiology, 2022, vol. 39, n° 3, p. 252–260. doi: 10.1097/EJA.0000000000001646
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ISSN of the journal0265-0215

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Creation11/15/2022 11:50:14 AM
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