A program to limit donor exposures to neonates undergoing extracorporeal membrane oxygenation.

Abstract:

OBJECTIVE:Extracorporeal membrane oxygenation (ECMO) has dramatically improved the survival of neonates with life-threatening respiratory and cardiac failure. However, ECMO requires numerous transfusions with significant risks. This study evaluated the effects of changing transfusion practices and blood component management on blood donor exposures in neonatal ECMO. DESIGN:A 3-year retrospective chart review of all neonatal ECMO patients from December 1989 through November 1992 was undertaken. During this 3-year period, transfusion practices and blood product preparation were altered twice to reduce blood donor exposures. The use of apheresis platelets and fresh frozen plasma (FFP), and preserving the expiration date on packed red blood cells (PRBCs) through the use of a sterile connecting device, allowed multiple transfusions from individual donor components. In addition, education of the ECMO physicians was focused on standardizing and reducing transfused volumes. Sixty-four surviving neonatal patients (91.4%) were evaluated. Five patients had excessive bleeding and were excluded from analysis. The remaining 59 patients were divided into three protocols based upon the transfusion practice at the time of their ECMO course. Protocol 1 received PRBCs less than 5 days of age, volume-reduced platelet concentrates, and standard FFP units up to 24 hours after thawing. Changes in transfusion practice for protocol 2 included extended outdate for PRBCs to 10 days, and using single donor apheresis platelet aliquots. The third protocol entailed the use single donor apheresis FFP aliquots in addition to the protocol 2 changes. RESULTS:Total PRBC transfusion volumes (721 +/- 406 ml for protocol 1, 637 +/- 172 ml for protocol 3) and associated blood donor exposures (5 +/- 2.1 for protocol 1, 3.9 +/- 0.9 for protocol 3) did not change substantially over the reviewed period. However, FFP transfusion volumes (478 +/- 170 ml for protocol 1, 274 +/- 63 ml for protocol 3), FFP-related donor exposures (4.5 +/- 1.6 for protocol 1, 1.2 +/- 0.4 for protocol 3) and platelet-related donor exposures (4.6 +/- 3.6 for protocol 1, 2.5 +/- 1.5 for protocol 3) were reduced progressively and significantly from protocol 1 to protocol 3 (P < .01, Tukey's B test adjusted for multiple comparisons). The total number of donor exposures per patient while on ECMO was decreased from 14.1 in protocol 1 to 10.0 in protocol 2 to 7.5 in protocol 3 (P < .01). CONCLUSIONS:We conclude that the changes in blood bank component selection and management as well as physician practice were effective in substantially reducing ECMO-related transfusion volumes and the resulting donor exposures.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Rosenberg EM,Chambers LA,Gunter JM,Good JA

subject

Has Abstract

pub_date

1994-09-01 00:00:00

pages

341-6

issue

3

eissn

0031-4005

issn

1098-4275

journal_volume

94

pub_type

杂志文章
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  • Fathers and the well-child visit.

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    doi:10.1542/peds.2005-1612

    authors: Garfield CF,Isacco A

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  • Effects of open-loop feedback on physical activity and television viewing in overweight and obese children: a randomized, controlled trial.

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    doi:10.1542/peds.2005-3052

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    更新日期:2006-07-01 00:00:00

  • Uninterrupted Infant Sleep, Development, and Maternal Mood.

    abstract:OBJECTIVES:Contrary to the importance of total sleep duration, the association between sleeping through the night and development in early infancy remains unclear. Our aims were to investigate the proportion of infants who sleep through the night (6- or 8-hour sleep blocks) at ages 6 and 12 months in a longitudinal coh...

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    更新日期:2018-12-01 00:00:00

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    doi:

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  • Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control.

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    authors: Gilman SE,Rende R,Boergers J,Abrams DB,Buka SL,Clark MA,Colby SM,Hitsman B,Kazura AN,Lipsitt LP,Lloyd-Richardson EE,Rogers ML,Stanton CA,Stroud LR,Niaura RS

    更新日期:2009-02-01 00:00:00

  • Developmental trajectories of daily activities in children and adolescents with cerebral palsy.

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    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

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    更新日期:2013-10-01 00:00:00

  • Mechanical vibration in neonatal transport.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

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    更新日期:1981-07-01 00:00:00

  • Recommendations for the prevention of Streptococcus pneumoniae infections in infants and children: use of 13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23).

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2010-1280

    authors: American Academy of Pediatrics Committee on Infectious Diseases.

    更新日期:2010-07-01 00:00:00

  • Lay Field-worker-Led School Health Program for Primary Schools in Low- and Middle-Income Countries.

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    journal_title:Pediatrics

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    doi:10.1542/peds.99.3.e5

    authors: Conseur A,Rivara FP,Emanuel I

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    journal_title:Pediatrics

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    doi:10.1542/peds.2006-2529

    authors: vandenBerg P,Neumark-Sztainer D,Cafri G,Wall M

    更新日期:2007-03-01 00:00:00

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    更新日期:2006-08-01 00:00:00

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

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    pub_type: 杂志文章

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    更新日期:2008-12-01 00:00:00

  • Toward creating family-friendly work environments in pediatrics: baseline data from pediatric department chairs and pediatric program directors.

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    journal_title:Pediatrics

    pub_type: 杂志文章

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    更新日期:2007-03-01 00:00:00

  • Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention.

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    pub_type: 杂志文章,随机对照试验

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  • A systematic review of treatments for infant colic.

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    journal_title:Pediatrics

    pub_type: 杂志文章,meta分析

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    更新日期:2000-07-01 00:00:00

  • Urinary tract infection in febrile infants younger than eight weeks of Age.

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    更新日期:1976-09-01 00:00:00

  • Children with special needs in England and Wales: the care of hearing impairment, myelomeningocele, and adolescent pregnancy.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

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  • Incidence and Prevalence of Childhood Epilepsy: A Nationwide Cohort Study.

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    pub_type: 杂志文章

    doi:10.1542/peds.108.5.e86

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

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    更新日期:1994-12-01 00:00:00

  • Serum immunoreactive pancreatic lipase and cationic trypsinogen for the assessment of exocrine pancreatic function in older patients with cystic fibrosis.

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    doi:

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