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Transfusion prevention using erythropoietin, parenteral sucrose iron, and fewer phlebotomies in infants born at ≤30 weeks gestation at a high altitude center: a 10-year experience

Journal of Perinatology volume 41, pages 1403–1411 (2021)Cite this article

Subjects

Abstract

Introduction

Red blood cell transfusions in infants born at ≤30 weeks gestation are frequent. Erythropoietin therapy reduces transfusions. An increase in hematocrit is an adaptive response at high altitudes but a guaranteed source of iron is necessary for adequate erythropoiesis.

Methods

A retrospective cohort study was done to compare red blood cell transfusion practices of the 2019 EpicLatino (EPIC) Latin America network database with a single unit at 2650 m above sea level (LOCAL). The data from LOCAL for three time periods were compared over 10 years based on changes in erythropoietin dose and fewer phlebotomies. The number of cases that received transfusions and the total number of transfusions required were compared. Adjustments were made for known risk factors using a multivariate regression analysis.

Results

Two hundred and twenty-one cases in LOCAL and 382 cases from EPIC were included. Overall basic demographic characteristics were similar. In EPIC a significantly higher rate of infection (28% vs. 15%) and outborn (10% vs. 1%) was found, but less necrotizing enterocolitis (9% vs. 15%) and use of prenatal steroids (62% vs. 93%) than LOCAL (p < 0.05). EPIC patients received more transfusions (2.6 ± 3 vs. 0.6 ± 1 times) than LOCAL (p < 0.001) and received them significantly more frequently (61% vs. 25%). Within the LOCAL time periods, no statistically significant differences were found other than the need for transfusions (1st 32%, 2nd 28%, 3rd 9%, p = 0.005) and the average number of transfusions (1st 0.8 ± 1.6, 2nd 0.7 ± 1.3, 3rd 0.1 ± 0.3, p = 0.004). These differences remained significant after multivariate regression analysis and adjusting for risk variables.

Conclusion

The combination of erythropoietin, parenteral sucrose iron, fewer phlebotomies during the first 72 h, and delayed umbilical cord clamping seem to reduce red blood cell transfusion needs. This can be extremely important in high altitude units where higher hematocrit is desirable but may also be valuable at sea level.

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Fig. 1: On the Y1 axis, mean pretransfusion hemoglobin (PrHb) in severely compromised babies (dark/blue columns) and in stable babies (light/red columns) is shown.
Fig. 2: Pretransfusion guidelines reported by the directors of the different EPIC units 2019 organized by values reported for severely compromised infants.

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Acknowledgements

We would like to thank EpicLatino, its board of directors, and the participating units for letting us use their data and for systematically entering the information to make it a reliable one and thus enabling this type of work. We also want to thank the people who work in the Clínica del Country unit for their dedication and fine work that made these results possible and Felipe Fajardo for his valuable input on this English paper.

Author information

Authors and Affiliations

  1. Division of Neonatology, Clínica del Country, Bogota, DC, Colombia

    Angela B. Hoyos

  2. Universidad El Bosque, Bogota, Colombia

    Angela B. Hoyos

  3. Sociedad de Cirugía Hospital de San José, Bogota, Colombia

    Pablo Vasquez-Hoyos

  4. Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia

    Pablo Vasquez-Hoyos

  5. Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia

    Pablo Vasquez-Hoyos

Authors
  1. Angela B. Hoyos
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  2. Pablo Vasquez-Hoyos
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ABH and PVH contributed equally to this research as authors. They were involved in planning and designing the study and participated in all stages of the project. ABH was involved in data extraction. ABH and PVH analyzed the data and described the results. Together, they wrote and approved the final paper.

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Correspondence to Angela B. Hoyos.

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Hoyos, A.B., Vasquez-Hoyos, P. Transfusion prevention using erythropoietin, parenteral sucrose iron, and fewer phlebotomies in infants born at ≤30 weeks gestation at a high altitude center: a 10-year experience. J Perinatol 41, 1403–1411 (2021). https://doi.org/10.1038/s41372-021-00945-7

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