title: Platelet Transfusion Practices Among Very-Low-Birth-Weight Infants.
abstract: Thrombocytopenia and intraventricular hemorrhage (IVH) are common among very-low-birth-weight (VLBW) infants. Survey results suggest that US neonatologists frequently administer platelet transfusions to VLBW infants with mild to moderate thrombocytopenia.
  
  
  
  To characterize platelet transfusion practices in US neonatal intensive care units (NICUs), to determine whether severity of illness influences platelet transfusion decisions, and to examine the association between platelet count (PCT) and the risk for IVH in the first 7 days of life.
  
  
  
  This multicenter, retrospective cohort study included 972 VLBW infants treated in 6 US NICUs, with admission dates from January 1, 2006, to December 31, 2007. Data were collected from all infants until NICU discharge or death (last day of data collected, December 4, 2008). Data were entered into the central database, cleaned, and analyzed from May 1, 2009, to February 11, 2016.
  
  
  
  Platelet transfusion.
  
  
  
  Number of platelet transfusions and incidence of IVH.
  
  
  
  Among the 972 VLBW infants (520 [53.5%] male; mean [SD] gestational age, 28.2 [2.9] weeks), 231 received 1002 platelet transfusions (mean [SD], 4.3 [6.0] per infant; range, 1-63 per infant). The pretransfusion PCT was at least 50 000/μL for 653 of 998 transfusions (65.4%) with this information. Two hundred eighty-one transfusions (28.0%) were given during the first 7 days of life. During that period, platelet transfusions were given on 35 of 53 days (66.0%) when the patient had a PCT less than 50 000/μL and on 203 of 436 days (46.6%) when the patient had a PCT of 50 000/μL to 99 000/μL. At least 1 marker of severe illness was present on 198 of 212 patient-days (93.4%) with thrombocytopenia (PCT, <100 000/μL) when a platelet transfusion was given compared with 113 of 190 patient-days (59.5%) with thrombocytopenia when no platelet transfusion was given. Thrombocytopenia was a risk factor for intraventricular hemorrhage during the first 7 days of life (hazard ratio, 2.17; 95% CI, 1.53-3.08; P < .001). However, no correlation was found between severity of thrombocytopenia and risk for IVH. After controlling for significant clinical factors and thrombocytopenia, platelet transfusions did not have a significant effect on the incidence of IVH (hazard ratio, 0.92; 95% CI, 0.49-1.73; P = .80).
  
  
  
  A large proportion of platelet transfusions were given to VLBW infants with PCT greater than 50 000/μL. Severity of illness influenced transfusion decisions. However, the severity of thrombocytopenia did not correlate with the risk for IVH, and platelet transfusions did not reduce this risk.
authors.affiliation: Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts2Division of Neonatology and Newborn Medicine, Massachusetts General Hospital for Children, Boston.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Sparger
authors.affiliation: Center for Epidemiological and Statistical Research, New England Research Institutes, Watertown, Massachusetts.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Assmann
authors.affiliation: Center for Epidemiological and Statistical Research, New England Research Institutes, Watertown, Massachusetts.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Granger
authors.affiliation: Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Abigail
authors.initials: A
authors.lastname: Winston
authors.affiliation: Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Christensen
authors.affiliation: Division of Neonatology, University of Iowa, Iowa City.
authors.forename: John A
authors.initials: JA
authors.lastname: Widness
authors.affiliation: Center for Transfusion and Cellular Therapies, Department of Pathology, Emory University, Atlanta, Georgia7Aflac Cancer Center and Blood Disorders, Department of Pediatrics, Emory University, Atlanta, Georgia.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Josephson
authors.affiliation: Center for Transfusion and Cellular Therapies, Department of Pathology, Emory University, Atlanta, Georgia7Aflac Cancer Center and Blood Disorders, Department of Pediatrics, Emory University, Atlanta, Georgia.
authors.forename: Sean R
authors.initials: SR
authors.lastname: Stowell
authors.affiliation: Division of Neonatology, University of Florida, Gainesville.
authors.forename: Matthew
authors.initials: M
authors.lastname: Saxonhouse
authors.affiliation: Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Martha
authors.initials: M
authors.lastname: Sola-Visner
mesh_terms: D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002552:Cerebral Ventricles; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D017713:Platelet Transfusion / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States