76: Minimizing Blood Losses and Reducing the Need for Transfusions in Low Birth Weight Infants: A Scoping Review of the Literature

Abstract

Background: Premature infants frequently develop anemia and often require transfusions. Packed red blood cells transfusions can be associated with complications, some potentially life-threatening. Best evidence of strategies to reduce blood loss and red blood cells transfusions has not previously been summarized in a single review and knowledge gaps in this area are unclear. Objectives: To perform a scoping review of the evidence on blood saving practices and strategies to reduce red blood cells transfusions in premature neonates. Design/Methods: Standard methodology for scoping reviews was followed. MEDLINE (1946 to April 15, 2013), Embase (1947 to April 15, 2013), and Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, March 2013) were searched using the Ovid interface. The target population included premature infants (<1500g or <37 weeks) during initial hospital admission. Interventions included recombinant human erythropoietin, the use of defined thresholds for transfusion, delayed cord clamping or cord milking, iron supplementation, techniques to obtain blood samples (capillary, venous or arterial), point of care testing and noninvasive monitoring techniques. Titles, abstract and full publications to include were independently reviewed by two of the authors. Results: A total of 1353 records were identified; 138 abstracts were selected and 37 full publications were reviewed and included in this review (Table 1). High quality evidence such as systematic reviews and randomized controlled trials have been performed for some interventions (erythropoietin, transfusion thresholds, delayed cord clamping and iron supplementation). Early erythropoietin and delayed cord clamping have been shown to reduce the need for blood transfusions. For blood sampling techniques and non-invasive monitoring, evidence is limited to prospective cohort studies and case series. Non invasive monitoring has shown variable reliability when compared to standard methods and point of care testing can reduce blood volume losses and the need for transfusions. Conclusions: Sufficient high quality evidence exists demonstrating that erythropoietin, transfusion thresholds, the use of delayed cord clamping reduce the need for transfusions. A gap has been identified in good quality research for strategies such as methods of point of care testing and non-invasive monitoring. (Table presented) .