Sarah J. Ilstrup

Is “transfusion-associated necrotizing enterocolitis” an authentic pathogenic entity?

BACKGROUND: Necrotizing enterocolitis (NEC) sometimes occurs after a transfusion, but it is unclear whether this is a chance association or cause and effect.

Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate: a pre-post analysis within a multihospital health care system.

BACKGROUND: We previously reported that in the year 2006, approximately 35% of the transfusions administered in the Intermountain Healthcare neonatal intensive care units (NICU) were noncompliant with our transfusion guidelines. In January 2009 we instituted an electronic NICU transfusion ordering and monitoring system as part of a new program to improve compliance with transfusion guidelines.

Reference intervals for common coagulation tests of preterm infants (CME)

Fresh‐frozen plasma (FFP) is sometimes administered to nonbleeding preterm neonates who are judged to be at risk for bleeding because they have abnormal coagulation tests. The benefits/risks of this practice are not well defined. One limitation to progress is lack of reference intervals for the common coagulation tests, thus limiting precision about whether coagulation tests are indeed abnormal.

Postponing or eliminating red blood cell transfusions of very low birth weight neonates by obtaining all baseline laboratory blood tests from otherwise discarded fetal blood in the placenta

BACKGROUND: Safely reducing the proportion of very low birth weight neonates (<1500 g) that receive a red blood cell (RBC) transfusion would be an advance in transfusion practice.

Association, among very‐low‐birthweight neonates, between red blood cell transfusions in the week after birth and severe intraventricular hemorrhage

Previous reports describe a statistical association, among very‐low‐birthweight (VLBW, <1500 g) neonates, between red blood cell (RBC) transfusion in the first days after birth and development of severe intraventricular (brain) hemorrhage (IVH).

Recent advances toward defining the benefits and risks of erythrocyte transfusions in neonates.

Like many treatments available to small or ill neonates, erythrocyte transfusions carry both benefits and risks. This review examines recent publications aimed at better defining those benefits and those risks, as means of advancing evidence-based neonatal intensive care unit transfusion practices. Since decisions regarding whether to not to order an erythrocyte transfusion are based, in part, on the neonates blood haemoglobin concentration, the authors also review recent studies aimed at preventing the haemoglobin from falling to a point where a transfusion is considered.

A high rate of compliance with neonatal intensive care unit transfusion guidelines persists even after a program to improve transfusion guideline compliance ended

When new guidelines aimed at better medical practice are introduced into a hospital, an initial period of enthusiasm and compliance can be followed by recidivism, with reemergence of previous practice patterns. Transfusions are a critical part of neonatal intensive care and indeed are life-saving for certain neonates but they carry risks as well as benefits. Thus, continually striving toward evidencebased neonatal intensive care unit (NICU) transfusion practices has the potential to improve outcomes and to reduce health care costs. Setting guidelines for transfusions has been advocated as one such step toward better transfusion practice. Intermountain Healthcare is a not-for-profit healthcare organization in the western United States. In this health care system we created a set of NICU transfusion guidelines and introduced these into practice. However, an audit we conducted in 2007 revealed that only 60% of the transfusions being given were compliant with the guidelines. In an effort to improve compliance, in January 2009 we instituted a new program consisting of electronic transfusion ordering, central monitoring of each transfusion, and issuance of monthly reports to each NICU showing their previous month’s compliance. For monitoring, transfusion orders were judged as compliant if the patient’s hemoglobin or platelet (PLT) count fell within the guideline ranges, which were shown on the computer screen. Neonatologists were able to order blood products even if the order was not compliant with guidelines. In a recent issue of TRANSFUSION we detailed this program and showed its success as measured by an increase in compliance from 60% to 90%, with a drop in transfusion rate and a financial saving of

More clearly defining the risks of erythrocyte transfusion in the NICU

780,074 over 12 months. That program ended in December 2009. The present analysis was undertaken more than 1 year later, to evaluate guideline compliance after the monthly reports and central oversight had ceased. During the 12 months after cessation of the new program, no further transfusion education efforts or transfusion compliance reports were given to the individual NICUs. No changes were made in the transfusion ordering process since implementation in January 2009. However, during these 12 months compliance remained more than 90%. In fact, during the year the program was in operation (2009), 88 13% of transfusions were compliant with the guidelines, compared with 96 2% in 2010 (p = 0.034). As shown in Table 1, transfusion rates in 2010 were lower than in each previous year. The reduced transfusion rate resulted in a

Novel GYP(A-B-A) hybrid gene in a DANE+ person who made an antibody to a high-prevalence MNS antigen

780,074 decrement in blood bank–associated charges in 2009 (compared with 2007 and 2008, as we previously reported). Using 2009 charge figures, the additional reduction in transfusion rate in 2010 accounted for a further charge decrement of

Association of neonatal red blood cell transfusion with increase in serum bilirubin

112,487, or an