Gerull, Roland

Nelle, Mathias

Wüest, Alyssa Laurence

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Aus der Universitatsklinik für Kinderheilkunde, lnselspital Bern Direktor: Prof. Dr. med. Christoph Aebi Arbeit unter der Leitung von Dr.med. Roland Gerull und PD Dr.med. Mathias Nelle Comparison of treatment strategies for anaemia of prematurity in extremely low birthweight infants between 1997 and 2011 lnaugurai-Dissertation zur Erlangung der Doktorwürde der Humanmedizin der Medizinischen Fakultat der Universitat Bern vorgelegt von Wüest Alyssa Laurence von Vex VS und Beromünster LU Publikation in Archives of Disease in Childhood Fetal & Neonatal Edition https://doi.org/1 0.1136/archdischild-2016-31 0752 Originaldokument gespeichert auf dem Webserver der Universitatsbibliothek Bern lS.'i?.1!.~ Dieses Werk ist unter einem Creative Commons Namensnennung-Keine kommerzielle Nutzung-Keine Bearbeitung 2.5 Schweiz Lizenzvertrag lizenziert. 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I LETTER Comparison of treatment strategies for anaemia of prematurity in extremely low birthweight infants between 1997 and 2011 Anaemia of prematurity (AOP) is a common sequela of preterm birth.1 It remains largely unknown how individual neonatal intensive care units (NICUs) manage AOP and whether treatment strat-egies have changed over time. We present the results of a standardised multicentre survey to assess the alterations in the treat-ment of AOP in N ICUs caring for extremely low birthweight (ELBW) infants comparing Germany in 1997 (n=125 NICUs) to German-speaking countries in 2011 (n = 129): Germany (n=1 10), Austria (n =10) and Switzerland (n=9) .Z Preparation strategies for red blood cells (RBCs), transfusion volume, and rate and protocols for erythropoietin administration were analysed. High response rates (63.6%, 1997; 66.2%, 2011) make our results representative for German-speaking countries: Treatment strategies for AOP in ELBW infants have changed significantly from 1997 to 2011 regarding RBC transfusion volume, rate and preparation (table 1). In 2011 , the transfusion of large volumes (15 and 16-20 mU kg) of RBCs had increased sig-nificantly compared with 1997; 45% vs 27% (p = 0.010) and 27% vs 16% (p = 0.042) of subjects, respectively. Only 26% ELBW infants received 10- 14 mUkg vs 51% (p < O.OOl) in 1997. Furthermore, transfusion rates were significantly faster; 27% of subjects received blood products at a rate of 5 mUhour vs 10% in 1997 (p < 0.001) and only 19% at a rate of <3 mU hour vs 42o/o in 1997 (p < O.OOl) . Finally, matching subgroup RBCs (p < O.OOl), cytomegalovirus negative (p < O.OOl), filtered (p = 0.002) and con-sanguineous blood products (p < 0.001) were administered less frequently in 2011 whereas the use of irradiated products (p < 0.001) had increased. No significant Table 1 Comparison of treatment strategies in ELBW infants between 1997 and 2011 1997 2011 (n=125) (n=129) Difference (%) (%) (%) 95% Cl p Value Preparation RBC Only 0 negative 34 37 3 - 10% to 14% 0.750 Similar subgroups 65 41 -24 - 36% to - 11 % <0.001 CMV negative 94 79 -15 - 24% to - 7% <0.001 Washed 26 15 -11 -21% to 0% 0.050 Irradiated 45 75 30 18% to 42% <0.001 Filtered 85 67 - 18 -28% to - 7% 0.002 Satellite packs 73 73 0 -1 1%to12% 0.995 No blood relationship 79 98 19 12% to 27% <0.001 Volume RBC (mUkg) <10 5 1 -4 - 10% to 1% 0.091 10-14 51 26 - 25 -37% to -1 1% <0.001 15 27 45 18 4% to 30% 0.010 16-20 16 27 11 0% to 23% 0.042 >20 1 1 0 - 5% to 4% 1.000 Rate RBC (mUh) <3 42 19 -23 -34% to - 10% <0.001 3 11 16 - 5% to 14% 0.326 3-5 25 26 - 11 %to12% 0.947 10 27 17 7% to 27% <0.001 5-10 12 12 0 - 9% to 9% 1.000 EPO Use EPO 37 27 -10 -22% to 2% 0.095 Dose EPO <750 IU/kg/week 15 750 IU/kg/week 51 >750 IU/kg/week 24 CMV, cytomegalovirus; ELBW, extremely low birth weight; EPO, erythropoietin; IU, international units; RBC, red blood cell. PostScript changes of erythropoietin administration were observed. Our results show a signifi-cant increase of both volume and rate of RBC transfusion, increased administration of irradiated products over time and, con-versely, less frequent use of matching sub-group RBCs, cytomegalovirus negative, filtered and consanguineous blood pro-ducts. Even though all countries visibly aim to reduce the risk for bloodborne infections and immunological reactions in ELBW infants, there is paucity of universal international transfusion guidelines for this target group.3 4 The strength of our study lies within the large sample size from Germany (1997), consolidated with pooled data from Germany, Austria and Switzerland (2011), which allows us to plausibly describe the changes in treat-ment strategies of AOP over 14 years. We therefore assume that our results represent actual current clinical practice and are not merely recommended treatment strategies. Further studies are warranted to examine the ideal volume and rate of RBC transfu-sion, time and quantity of erythropoietin administration as well as immediate and long-term transfusional adverse events. Alyssa Wuest, 1 Helen Manser, 2 Helmut Kuster, 3 Ruth Mari Uill~en,4 Tina Arenz, s Stephan Arenz, 2 Mathias Nelle, Roland Gerul\2 1Department of Neonatology, Children's Hospital Kantonsspital Aarau, Aarau, Switzerland 2Division of Neonatology, lnselspital, University of Bern, Bern, Switzerland 3Division of Neonatology, Children's Hospital, University of Giittingen, Giittingen, Germany 4Pediatric Emergency Department, lnselspital, University of Bern, Bern, Switzerland sDepartment of Pediatrics, lnselspital, University of Bern, Bern, Switzerland Correspondence to Dr Roland Gerull, Division of Neonatology, lnse\spital, University of Bern, Bern CH-30 10, Switzerland; roland.gerull@insel.ch Contributors AW analysed the data, performed the literature research and wrote 1he first draft of the manuscript. TAwas responsible for development and realisation of the firs1 survey. HK supervised the development and contributed to the real isation of the first survey. RG was involved in the design of the second questionnaire, centre recruitment and data analysis, and reviewed the manuscript for intelledual content and approved the final version. HM designed the second questionnaire, developed 1he database, was responsible for data management and centre recruitment. SA was responsible for centre recruitment, development of the database of the second questionnaire. MN supervised the development and realisation of the second survey and acquired hospital funds for the incentive. RML critically reviewed the manuscript for important intelledual content and approved the final version. All listed authors on the manuscript have seen and approved the submitted version of the manuscript and take full responsibi lity for the manuscript. Competing interests None declared. BMI Arch Dis Child Fetal Neonatal Ed Month 20 16 Vol 0 No 0 ~C~~~ F1 Copyrigh t Article author (or their employer) 2016. Produced by BMJ Publishing Group Ltd (& RCPCH) under licence. Downloaded from http://fn .bmj.com/ on June 13, 2016 - Published by group.bmj.com PostScript Provenance and peer review Not commissioned; internally peer reviewed. To cite Wuest A, Manser H, Kuster H, eta/. Arch Dis Child Fetal Neonatal Ed Published Onl ine First: ]please include Oay Month Year] doi: 1 0.1136/archdischild-2016-3 10752 Accepted 19 May 2016 Arch Dis Child Fetal Neonatal Ed 2016;0:F1-F2. doi: 1 0.11361archdischild-2016-31 0752 F2 REFERENCES Strauss RG. Anaemia of prematurity: pathophysiology and treatment. Blood Rev 2010;24:221-5. Gerull R, Manser H, Kuster H, et a!. Increase of caffeine and decrease of corticosteroids for extremely low-birthweight infants with respiratory failure from 1997 to 2011. Acta Paediatr 2013; 102:1154-9. Cross-Sectional Guidelines for Therapy with Blood Components and Plasma Derivatives. 4th revised edition. Bundesarztekammer (German Medical Association). 4 Guideline for transfusion of blood and blood products, Austria 2005. http://www.oegbt.at/wp-content/statid Richtlinien_Empfehlungen/KAV _Wien_Leitlinie_ Transfusion_ von_Biut_u nd_Biutprodukten_ v 3 _200 5. pdf Arch Dis Child Fetal Neonatal Ed Month 20 16 Vol 0 No 0 Downloaded from http://fn .bmj.com/ on June 13, 2016 - Published by group.bmj.com References Email alerting service Notes Comparison of treatment strategies for anaemia of prematurity in extremely low birthweight infants between 1997 and 2011 Alyssa Wuest, Helen Manser, Helmut Kuster, Ruth Mari Lollgen, Tina Arenz, Stephan Arenz, Mathias Nelle and Roland Gerull Arch Dis Child Fetal Neonatal Ed published online June 10, 2016 Updated information and services can be found at: http:l/fn.bmj.com/content/early/2016/06/1 0/archdischild-2016-31 0752 These include: This article cites 2 articles , 0 of which you can access for free at: http:l/fn.bmj.com/content/early/2016/06/1 0/archdischild-2016-31 0752 #BIBL Receive free email alerts when new articles cite this article . 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Comparison of treatment strategies for anaemia of prematurity in extremely low birthweight infants between 1997 and 2011

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Comparison of treatment strategies for anaemia of prematurity in extremely low birthweight infants between 1997 and 2011

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