Survey of transfusion practices in preterm infants in Europe

BACKGROUND Preterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data. METHODS From October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries. RESULTS Responses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×10$^{9}$/L in non-bleeding infants of GA of <28 weeks, while the 25×10$^{9}$/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs. CONCLUSIONS Transfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice

Kurveslurvkampanje. Kvalitetsarbeid i praksis – teori, prosjekt og refleksjoner

Det har vært mange initiativ og kampanjer for pasientsikkerhet og kvalitetsforbedring i helsevesenet. Mye av arbeidet har vært drevet fra toppen, og det har vært utfordrende å få ut mer systematisk kvalitetsarbeid i klinisk praksis. Jeg ønsket å gjøre et lite prosjekt på avdelingen for å komme i gang med dette viktige arbeidet. Ukeskurvene fungerer på nyfødtintensivavdelingen som en oppsummering av behandling og viktige observasjoner, i tillegg til forordning av medikamenter og dokumentasjon. Ukeskurvene brukes av flere yrkesgrupper døgnet rundt og er et viktig kommunikasjonsredskap, et mikrosystem hvor den faktiske pasientbehandlingen foregår. Korrekt kurveføring kan være viktig for kvaliteten, og bedre pasientsikkerheten. Kurvene ble scoret to ganger, før og etter en intervensjonsperiode. Intervensjonen bestod i plakater, e-post, oppfordring til å ta e-læringsprogram, lunsjmøter og seminar. Av de 9 kvalitetspunktene som ble scoret og vurdert, var det en statistisk signifikant forbedring på 2 punkter; medikamentforordninger og registrering av hva som var gitt av behandling. Kampanjen ble godt mottatt, og inspirerte til videre kvalitetsinitiativ. I nyere litteratur om pasientsikkerhetsarbeid er det diskutert at tradisjonelle lineære årsaksanalyser er utilstrekkelig for å forstå helsevesenets kompleksitet. Man trenger også å studere det positive som gjør at det faktisk fungerer i de fleste tilfellene, og hvordan helsearbeidere er fleksible og oppnår sikkerhet i praksis

Preeclampsia biomarkers in fetal circulation : Oxidative stress, inflammation, homocysteine and angiogenic factors

Preeclampsia is complicating 3.7 % of pregnancies, and is defined by hypertension and proteinuria, with signs of endothelial dysfunction, probably caused by placentally derived factors. The fetal consequences of preeclampsia include intrauterine growth restriction and premature delivery. Preeclampsia is associated with increased maternal oxidative stress and inflammation, as well as elevated circulating concentrations of homocysteine and the anti-angiogenic factor sFlt-1 (soluble fms-like tyrosine kinase 1). This study further explores these biomarkers of preeclampsia in the fetal circulation at delivery. Maternal and fetal blood samples were obtained at cesarean section from preeclamptic and normal pregnancies at Ulleval University Hospital. No evidence of increased oxidative stress or inflammation was found in the fetal circulation in infants of preeclamptic mothers as compared to controls. Increased maternal concentration of homocysteine and sFlt-1 in preeclampsia was reflected in the fetal circulation, and both biomarkers are associated with development of endothelial dysfunction

Fatigue in primary Sjögren's syndrome: A proteomic pilot study of cerebrospinal fluid

Objectives: Fatigue is a frequent and often disabling phenomenon that occurs in patients with chronic inflammatory and immunological diseases, and the underlying biological mechanisms are largely unknown. Because fatigue is generated in the brain, we aimed to investigate cerebrospinal fluid and search for molecules that participate in the pathophysiology of fatigue processes. Methods: A label-free shotgun proteomics approach was applied to analyze the cerebrospinal fluid proteome of 20 patients with primary Sjögren’s syndrome. Fatigue was measured with the fatigue visual analog scale. Results: A total of 828 proteins were identified and the 15 top discriminatory proteins between patients with high and low fatigue were selected. Among these were apolipoprotein A4, hemopexin, pigment epithelium-derived factor, secretogranin-1, secretogranin-3, selenium-binding protein 1, and complement factor B. Conclusion: Most of the discriminatory proteins have important roles in regulation of innate immunity, cellular stress defense, and/or functions in the central nervous system. These proteins and their interacting protein networks may therefore have central roles in the generation and regulation of fatigue, and the findings contribute with evidence to the concept of fatigue as a biological phenomenon signaled through specific molecular pathways

Fatigue in primary Sjögren’s syndrome: A proteomic pilot study of cerebrospinal fluid

Objectives: Fatigue is a frequent and often disabling phenomenon that occurs in patients with chronic inflammatory and immunological diseases, and the underlying biological mechanisms are largely unknown. Because fatigue is generated in the brain, we aimed to investigate cerebrospinal fluid and search for molecules that participate in the pathophysiology of fatigue processes. Methods: A label-free shotgun proteomics approach was applied to analyze the cerebrospinal fluid proteome of 20 patients with primary Sjögren’s syndrome. Fatigue was measured with the fatigue visual analog scale. Results: A total of 828 proteins were identified and the 15 top discriminatory proteins between patients with high and low fatigue were selected. Among these were apolipoprotein A4, hemopexin, pigment epithelium-derived factor, secretogranin-1, secretogranin-3, selenium-binding protein 1, and complement factor B. Conclusion: Most of the discriminatory proteins have important roles in regulation of innate immunity, cellular stress defense, and/or functions in the central nervous system. These proteins and their interacting protein networks may therefore have central roles in the generation and regulation of fatigue, and the findings contribute with evidence to the concept of fatigue as a biological phenomenon signaled through specific molecular pathways

Microbiota development in preterm and term infants

Microbiota development in (pre)term infants receiving various durations of postpartum antibiotic treatment. Determined through 16S rRNA gene amplicon sequencing (MiSeq, Illumina

Microbiota development in preterm and term infants

Microbiota development in (pre)term infants receiving various durations of postpartum antibiotic treatment. Determined through 16S rRNA gene amplicon sequencing (MiSeq, Illumina

Microbiota development in preterm and term infants

Microbiota development in (pre)term infants receiving various durations of postpartum antibiotic treatment. Determined through 16S rRNA gene amplicon sequencing (MiSeq, Illumina

Enhanced nutrition improves growth and increases blood adiponectin concentrations in very low birth weight infants

Background: Adequate nutrient supply is essential for optimal postnatal growth in very low birth weight (VLBW, birth weight<1,500 g) infants. Early growth may influence the risk of metabolic syndrome later in life. Objective: To evaluate growth and blood metabolic markers (adiponectin, leptin, and insulin-like growth factor-1 (IGF-1)) in VLBW infants participating in a randomized nutritional intervention study. Design: Fifty VLBW infants were randomized to an enhanced nutrient supply or a standard nutrient supply. Thirty-seven infants were evaluated with growth measurements until 2 years corrected age (CA). Metabolic markers were measured at birth and 5 months CA. Results: Weight gain and head growth were different in the two groups from birth to 2 years CA (weight gain: pinteraction=0.006; head growth: pinteraction=0.002). The intervention group improved their growth z-scores after birth, whereas the control group had a pronounced decline, followed by an increase and caught up with the intervention group after discharge. At 5 months CA, adiponectin concentrations were higher in the intervention group and correlated with weight gain before term (r=0.35) and nutrient supply (0.35≤r≤0.45). Leptin concentrations correlated with weight gain after term and IGF-1 concentrations with length growth before and after term and head growth after term (0.36≤r≤0.53). Conclusion: Enhanced nutrient supply improved early postnatal growth and may have prevented rapid catch-up growth later in infancy. Adiponectin concentration at 5 months CA was higher in the intervention group and correlated positively with early weight gain and nutrient supply. Early nutrition and growth may affect metabolic markers in infancy.Clinical Trial Registration (ClinicalTrials.gov) no.: NCT0110321

Estimated daily intake of phthalates, parabens, and bisphenol A in hospitalised very low birth weight infants

Very low birth weight infants (VLBW, birth weight (BW) 1 indicates that EDI exceeded TDI with increased risk of adverse health effects. EDI was higher in VLBW infants compared to term-born infants and older children. VLBW infants born at earlier gestational age (GA), or with lower BW, had higher EDI than infants born at later GA or with higher BW. First week median EDI for BPA was higher than TDI in 100% of infants, in 75% for di(2-ethylhexyl) phthalate (DEHP), 90% for the sum of butyl benzyl phthalate (BBzP), di-n-butyl phthalate (DnBP), DEHP and di-iso-nonyl phthalate (DiNP) = ∑BBzP+DnBP+DEHP+DiNP, and in 50% of infants for propylparaben (PrPa), indicating increased risk of adverse effects. Fifth week EDI remained higher than TDI in all infants for BPA, in 75% for DEHP and ∑BBzP+DnBP+DEHP+DiNP, and 25% of infants for PrPa, indicating prolonged risk. Maximum EDI for di-iso-butyl phthalate was higher than TDI suggesting risk of adverse effects at maximum exposure. VLBW infants born earlier than 28 weeks GA had higher EDI, above TDI, for PrPa compared to infants born later than 28 weeks GA. Infants with late-onset septicaemia (LOS) had higher EDI for DEHP, ∑BBzP+DnBP+DEHP+DiNP and BPA, above TDI, compared to infants without LOS. More 75% of the infants' EDI for DEHP and ∑BBzP+DnBP+DEHP+DiNP, 25% for PrPa, and 100% of infants' EDI for BPA, were above TDI resulting in HQs 1, indicating increased risk of adverse health effects