Platelet transfusions in the neonatal intensive care unit:factors predicting which patients will require multiple transfusions.
BACKGROUND
Previous studies suggest that recombinant thrombopoietin (rTPO) will increase platelet production in thrombocytopenic neonates. However, the target populations of neonates most likely to benefit should be defined. Studies suggest that rTPO will not elevate the platelet count until 5 days after the start of treatment. Therefore, the neonates who might benefit from rTPO are those who will require multiple platelet transfusions for more than 5 days. This study was designed to find means of prospectively identifying these patients.


METHODS
A historic cohort study of all patients in the neonatal intensive care unit (NICU) at the University of Florida who received platelet transfusions from January 1, 1997, through December 31, 1998, was conducted.


RESULTS
Of the 1389 patients admitted to the NICU during the study period, 131 (9.4%) received platelet transfusions. Seventeen were treated with extracorporeal membrane oxygenation and were excluded from further analysis. Of the remaining 114 patients, 55 (48%) received one transfusion and 59 (52%) received more than one transfusion (21 had >4). None of the demographic factors examined predicted multiple platelet transfusions. However, two clinical conditions did; liver disease and renal insufficiency. Neonates who received one platelet transfusion had a relative risk of death 10.4 times that in neonates who received none (p = 0.0001). Neonates who received >4 platelet transfusions had a risk of death 29.9 times that in those who received no transfusions (p = 0.0001).


CONCLUSIONS
NICU patients with liver disease or renal insufficiency who receive one platelet transfusion are likely to receive additional transfusions. Therefore, these patients constitute a possible study population for a Phase I/II rTPO trial.
Del Vecchio
A
A
Division of Neonatology, Department of Pediatrics, University of Florida, College of Medicine, Gainesville, Florida, USA.
Sola
M C
MC
Theriaque
D W
DW
Hutson
A D
AD
Kao
K J
KJ
Wright
D
D
Garcia
M G
MG
Pollock
B H
BH
Christensen
R D
RD
D015331:Cohort Studies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D017713:Platelet Transfusion; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors