The following is a summary of “Effect of minimization of early blood sampling losses among extremely premature neonates- A randomized clinical trial,” published in the March 2024 issue of Pediatrics by Balasubramanian et al.
This study aimed to assess the impact of blood sampling stewardship on transfusion requirements among infants born extremely preterm. Conducted as a single-center, randomized controlled trial, the study enrolled infants born at less than 28 weeks of gestation and weighing less than 1000 grams, who were randomized at 24 hours of age into two groups: restricted sampling and conventional sampling. The restricted sampling intervention involved targeted reductions in blood sampling volume and frequency alongside the utilization of point-of-care testing methods during the first six weeks after birth. Both groups received early recombinant erythropoietin from day three of age.
The primary outcome measure was the rate of early red blood cell (RBC) transfusions within the first six postnatal weeks. A total of 102 infants, with a mean gestational age of 26 weeks and a birth weight of 756 grams, were included in the study. Compliance with the sampling protocol was high, observed in 95% of the infants. Results indicated significantly lower sampling losses in the first six weeks in the restricted sampling group compared to the conventional sampling group (16.8 ml/kg vs 23.6 ml/kg, P<0.001). Additionally, the restricted sampling group exhibited a substantially lower rate of early postnatal RBC transfusion (41% versus 73%, RR: 0.56 [0.39-0.81], P=0.001). Moreover, the hazard of requiring a transfusion during the neonatal intensive care unit (NICU) stay was reduced by 55% in the restricted sampling group. Importantly, mortality and neonatal morbidities were comparable between the two groups.
In conclusion, minimizing blood sampling losses by approximately one-third during the first six weeks after birth resulted in a notable reduction in the early RBC transfusion rate among infants born extremely preterm with a birth weight of less than 1000 grams.
Source: sciencedirect.com/science/article/abs/pii/S0022347624001057
