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Christensen R.D.,University of Utah | Henry E.,Women and Newborns Program | Henry E.,Institute for Healthcare Delivery Research | Bennett S.T.,Intermountain Medical Center | Yaish H.M.,University of Utah
Journal of Perinatology | Year: 2016

Objective:The automated reticulocyte parameters (absolute reticulocyte count, immature reticulocyte fraction (IRF) and reticulocyte hemoglobin content (RET-He)) are of value in managing adults and older children with a variety of hematological disorders. However, the lack of reference intervals for these parameters in neonates and young infants has limited their application to that population.Study Design:During a span of 12 months (29 May 2014 to 5 May 2015), a convenience sample of reticulocyte parameters were run from clinically ordered complete blood counts (CBCs) of infants within the first 90 days after birth. Measuring the reticulocyte parameters as a research-only adjunct to the CBC did not require any additional blood or generate a patient charge, and the reticulocyte results were not reported to the provided and did not appear in the clinical records. Values from neonates who had a transfusion or a diagnosis of anemia were subsequently excluded from the reference data set.Results:Nine Intermountain Healthcare clinical laboratories contributed 8438 CBCs to the initial reticulocyte parameter database. From these, 1806 were excluded because of a transfusion or a diagnosis of anemia, leaving 6632 in the reference interval database. The parameters charted over the first 90 days after birth were: (1) blood hemoglobin concentration (g dl -1), (2) mean corpuscular volume (fL), (3) reticulocyte count (x10 3 per μl), (4) IRF (%) and (5) RET-He (pg).Conclusions:The new reference interval charts can help clinicians identify abnormalities in the reticulocyte parameters. This information could be of value in identifying and following neonates with various hematological problems including hemolytic disorders, occult hemorrhage, or iron deficiency or other limitations of erythrocyte production. © 2016 Nature America, Inc. Source


Del Vecchio A.,Neonatal Intensive Care Unit | Motta M.,Neonatal Intensive Care Unit | Radicioni M.,Neonatal Intensive Care Unit | Christensen R.D.,Women and Newborns Program
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2012

Platelet transfusions are the principal means of treating thrombocytopenia in neonatal intensive care units (NICUs), and are generally used as treatment of thrombocytopenic neonates who have active bleeding and as prophylactic administration in thrombocytopenic neonates who do not have hemorrhage but appear to be at high risk for bleeding. In this article, we summarize the rationale, benefits and risks of platelet transfusions in neonates. We review the importance of choosing the best product available for platelet transfusion, and we emphasize the importance of adopting and adhering to transfusion guidelines. © 2012 Informa UK, Ltd. Source


Christensen R.D.,Women and Newborns Program | Del Vecchio A.,Neonatal Intensive Care Unit | Ilstrup S.J.,Transfusion Medicine
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2012

Objective: Red blood cell (RBC) transfusions convey benefits but they also carry risks. Among NICU patients, some transfusion risks are well defined and their occurrence odds can be estimated and weighed against benefits. However other risks are poorly defined and it is not currently possible to estimate their occurence adds or weigh these aganist benefits. Methods: We reviewed publications in the past 15 years, listed in PubMed, dealing with risks and benefits of RBC transfusions to newborn infants. Results: Risks of RBC transfusion to adult patients decreased significantly with the advent of nucleic acid testing for viral pathogens. However, new or previously unknown risks of transfusions have been suggested for neonatal recipients. These include developmental delay, intraventricular hemorrhage, and necrotizing enterocolitis. These potential transfusion risks are all currently in the form of statistical associations, and cause-and-effect relationships have not been proven. Mean of reducing transfusions, tested during the past 15 years, include adopting transfusions guidelines, erythropoietic stimulating agents, delayed cord clamping, cord stripping, drawing all NICU admission blood tests from the placenta, and limiting phlebotomy losses for blood testing. Discussion: We advocate always attempt to weigh benefits and risks when ordering a transfusion for a neonatal patient. Certainly some such are life-saving or otherwise clearly beneficial. Perhaps others carry risks unbalanced by meager benefit. Efforts to improve NICU transfusion practice have been proposed and appear to be working to diminish costs and improve outcomes. © 2012 Informa UK, Ltd. Source


Christensen R.D.,Women and Newborns Program | Henry E.,Women and Newborns Program | Del Vecchio A.,Neonatal Intensive Care Unit
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2012

Objective: Quantitative and qualitative platelet abnormalities of neonates must be defined using evidence-based reference ranges, constructed according to gestational and postnatal age. Methods: Platelet counts, and demographic and outcome data, were obtained from neonates in the Intermountain Healthcare system in the western USA and template bleeding times were determined from neonates in Italy. Results: Reference ranges were constructed by excluding values from neonates with diagnoses associated with abnormal platelet counts (small for gestational age (SGA), pregnancy-induced hypertension (PIH), infection and necrotizing enterocolitis (NEC)). Values remaining in the database after excluding these diagnoses were organized into 5th to 95th percentile ranges. At 2325 weeks gestation, thrombocytopenia (<5th percentile) was defined by a platelet count <100,000/l. Severe thrombocytopenia (platelet count <50,000/l) occurred in 2.4% of neonatal intensive care unit (NICU) admissions and was largely due to acquired consumptive causes (bacterial and fungal sepsis, NEC and extracorporeal membrane oxygenation). No correlation was found between platelet count and subsequent central nervous system (CNS), pulmonary or gastrointestinal (GI) bleeding. The mortality rate did not correlate with the lowest platelet count but was proportionate to the number of platelet transfusions received. Platelet transfusions, administered according to guidelines, were given to 7% of NICU admissions, but a change in the guidelines from "count-based" to "mass-based" was associated with a reduction to 4%, with no increase in CNS, pulmonary, GI or cutaneous haemorrhage. Bleeding times were twice as long in neonates <33 weeks gestation as in term neonates, and shortened to term values by day of life ten. Conclusions: When reference ranges for platelets, appropriate to gestational and postnatal ages, are used, more uniformity occurs in definitions. This uniformity will foster consistency in diagnosis, treatment and outcomes-reporting. © 2012 Informa UK, Ltd. Source


Christensen R.D.,Women and Newborns Program | Baer V.L.,Women and Newborns Program | Del Vecchio A.,Neonatal Intensive Care Unit | Henry E.,Women and Newborns Program
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2013

Red blood cell transfusions can be life-saving for neonates with severe anemia or active hemorrhage. However, risks of transfusions exist and should always be weighed against potential benefits. At least two transfusion risks are unique to very low birth weight neonates. The first is an association between transfusions given in the first days after birth and the subsequent occurrence of a grade 3 or 4 intraventricular hemorrhage. The second is an association between "late" RBC transfusions and the subsequent occurrence of necrotizing enterocolitis. Much remains to be discovered about the pathogenesis of these two outcomes. Moreover, work is needed to clearly establish whether transfusions are causatively-associated with these outcomes or are co-variables. This review will provide basic data establishing these associations and propose mechanistic explanations. © 2013 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted. Source

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