Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

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

Geología y estratigrafía de la hoja 3246-ii Miramar, Costa Rica Geology and stratigraphy of the sheet 3246-ii Miramar, Costa Rica

Las rocas más antiguas de la hoja Miramar están conformadas por los sedimentos de la Formación Punta Carballo del Mioceno que afloran al SO de la hoja. Las vulcanitas del Grupo Aguacate (Mioceno-Plioceno) sobreyacidas por vulcanitas de la Formación Monteverde (Pleistoceno Inferior), representan la mayor extensión del mapa. En menor superficie se encuentran las ignimbritas del Plioceno hasta Pleistoceno y sedimentos del Cuaternario. Nuevas dataciones con el método K-Ar establecieron edades de 4,41±0,15 y 4,99±0,36 Ma para el Grupo Aguacate y de 1,77±0,11 y 1,71±0,22 Ma para la Formación Monteverde. El Grupo Aguacate también está conformado por una serie de cuerpos intrusivos de composición variable, entre ellos un stock gabrodiorítico que fue recién mapeado y se describe por primera vez con este trabajo. Se hicieron nuevas dataciones K-Ar del domo riodacítico cerro La Cruz, cuya edad fue datada en 1,71±0,14 Ma y del domo cerro San Miguel en 1,59±0,12 Ma. La definición de las unidades volcánicas se basa en la petrografía detallada de las rocas, así como en los resultados de la difractometría de rayos X, microsonda electrónica y 33 análisis químicos.The oldest rocks of the Miramar sheet are represented by sediments of the Punta Carballo Formation (Miocene), which are exposed at the SW corner. However, volcanic rocks of the older Aguacate Group (Miocene-Pliocene) and overlying Monteverde Formation (Lower Pleistocene) dominate the area. The Pliocene to Pleistocene silicic ignimbrites and Quaternary sediments are subordinate. New K-Ar ages yielded 4,41±0,15 to 4,99±0,36 Ma for the Aguacate Group and 1,71±0,22 to 1,77±0,11 Ma for the Monteverde Formation. Gabrodioritic stock was newly mapped in the Aguacate Group accompanying numerous other intrusive bodies of variable composition. New K-Ar ages were obtained for the rhyodacitic domes: 1,71±0,14 Ma for the cerro La Cruz Dome and 1,59±0,12 Ma for the cerro San Miguel Dome. Definition of volcanic units is based on detailed petrography, XRD, microprobe and 33 new bulk-rock chemical analyses