In a recent retrospective analysis, researchers characterized risks of intraventricular hemorrhage (IVH) and mortality in preterm infants. The researchers reported their findings in the journal JAMA Network Open.
“In our study, platelet transfusion was significantly associated with mortality, and every additional transfusion was associated with a 0.5-fold increase in mortality risk among preterm infants,” the researchers wrote in their report.
Neonates being treated in neonatal intensive care units (NICUs) experience thrombocytopenia at a rate of 20% to 50%, the researchers explained in their report. Those who have severe thrombocytopenia face major bleeding at a rate of 5% to 15%.
Often platelet transfusions are used to manage severe thrombocytopenia in neonates, but outcomes with this approach have been unclear. For this reason, the researchers had goals of identifying practices for platelet transfusions in preterm infants at a center in China and to identify outcomes associated with receiving platelet transfusions.
The researchers performed this retrospective cohort study at a NICU referral center, the Seventh Medical Center of PLA General Hospital in Beijing, China. Infants included in the study had been delivered preterm and had been given mechanical ventilation while hospitalized at this center between May 2016 and October 2017. Several demographic and clinical characteristics were evaluated based on electronic medical record data. The main study outcomes included any-grade IVH, severe IVH (defined as grade 3 or 4), and in-hospital mortality.
A total of 1221 preterm infants were included and they had a median gestational age of 31 weeks (interquartile range, 29-33 weeks). Platelet transfusions were administered to 7.7% of the patients.
In an adjusted analysis, there was a significant relationship between platelet transfusion and mortality (hazard ratio [HR], 1.48, 95% CI, 1.13-1.93; P =.004). Additionally, reductions in platelet count showed associations with multiple outcomes. These included mortality (HR per 50×103/mL, 1.74, 95% CI, 1.48-2.03; P <.001), any-grade IVH (HR per 50×103/mL, 1.13, 95% CI, 1.05-1.22; P =.001), and severe IVH (HR per 50×103/mL, 1.16, 95% CI, 1.02-1.32; P =.02).
A decreased risk of mortality, however, was seen with a larger mean platelet volume (HR, 0.83, 95% CI, 0.69-0.98; P =.03). The mean platelet volume also appeared to be a source of variation in IVH and mortality risks associated with transfusions.
A higher platelet count was linked to greater risks of IVH and mortality in association with platelet transfusions. A platelet count of 25×103/mL at the time of transfusion was associated with an HR for mortality of 1.20 (95% CI, 0.89-1.62), while a platelet count of 100×103/mL at the time of transfusion was associated with an HR of 1.40 (95% CI, 1.08-1.82).
The researchers concluded that in this study, a lower platelet count and thrombocytopenia were linked to greater risks of IVH and mortality, while greater mean platelet volume was linked to lower mortality risk. However, the researchers also considered the study’s results to suggest that transfusion-related risks may be linked to platelet count and mean platelet volume at the time of transfusion.
Chen C, Wu S, Chen J, et al. Evaluation of the association of platelet count, mean platelet volume, and platelet transfusion with intraventricular hemorrhage and death among preterm infants. JAMA Netw Open. 2022;5(10):e2237588. doi:10.1001/jamanetworkopen.2022.37588.