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Robert D Christensen - One of the best experts on this subject based on the ideXlab platform.
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neonates results in higher hemoglobin and fewer RBC Transfusions
2020Co-Authors: Vickie L. Baer, Diane K. Lambert, Patrick D. Carroll, Erick Gerday, Robert D ChristensenAbstract:OBJECTIVE: We previously described a method for reducing early phlebotomy losses from very low birth weight (VLBW) neonates by obtaining the initial blood tests from otherwise discarded fetal blood from the placenta. In the present study we sought to; (1) measure the feasibility of performing this method in actual practice, (2) test the hypothesis that this method would result in higher hemoglobin concentrations and lower Erythrocyte Transfusion rates in the first week after birth. METHODS: We conducted two studies in three Intermountain Healthcare NICUs. The first was a feasibility analysis involving 96 VLBW neonates, measuring the success of obtaining the NICU admission laboratory blood tests this way. The second study used case–control methodology to test the hypothesis that this method would result in a higher blood hemoglobin 12 to 24 h after birth, and a lower proportion receiving an Erythrocyte Transfusion in the first week. RESULT: In 91 of 96 VLBW neonates (95%) the initial blood tests were successfully obtained with this method. The success rate was not diminished by delayed cord clamping or cord milking, as it was successful in 35 of 36 (97%) such instances. Cases and controls were well matched on demographic and level of illness comparisons. Among cases the hemoglobin generally increased between birth and 12 to 24 h later, but among controls the hemoglobin generally decreased (Po0.05). In the week following birth fewer cases received vasopressors (Po0.01) and Erythrocyte Transfusions (Po0.001). CONCLUSION: We judge that it is feasible to collect the initial blood tests of VLBW neonates using otherwise discarded umbilical cord/placental blood, in that this can be accomplished in about 95% of VLBW deliveries. This method, which can be used in addition to either delayed clamping of the umbilical cord or cord milking, results in higher hemoglobin concentrations, less vasopressor use and fewer Transfusions in the first week.
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instituting a program to reduce the Erythrocyte Transfusion rate was accompanied by reductions in the incidence of bronchopulmonary dysplasia retinopathy of prematurity and necrotizing enterocolitis
Journal of Maternal-fetal & Neonatal Medicine, 2013Co-Authors: Del Vecchio A, Erick Henry, G Damato, A Cannuscio, L Corriero, M Motta, Robert D ChristensenAbstract:AbstractBronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) all likely involve oxidative damage to immature tissues. It has been postulated that Transfusions of adult Erythrocytes contribute to the risk of developing these morbidities, as a consequence of adult hemoglobin releasing non-physiological quantities of O2 to developing tissues. In 2009, we instituted a concerted effort to diminish Erythrocyte Transfusions in our NICU, and in 2013 we performed a before vs. after practice change analysis of the incidence of BPD, ROP and NEC during the 8-year period spanning this change. The Transfusion rate fell from a high of 14.8% of admissions in 2007 to a low of 6.3% in 2011 (p < 0.001). Concordant with this reduction patients had a lower incidence of; BPD (from 3.2% to 0.9%; OR, 3.722; CI 1.897–7.302), ROP (from 4.6% to 2.4%; OR 1.958, CI 1.247–3.073), and a trend toward less NEC (from 0.7% to 0.2%; OR 3.090, CI 0.835–11.443).
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Instituting a program to reduce the Erythrocyte Transfusion rate was accompanied by reductions in the incidence of bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis
Journal of Maternal-fetal & Neonatal Medicine, 2013Co-Authors: Del Vecchio A, Erick Henry, M Motta, D'amato G, Cannuscio A, Corriero L, Robert D ChristensenAbstract:AbstractBronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) all likely involve oxidative damage to immature tissues. It has been postulated that Transfusions of adult Erythrocytes contribute to the risk of developing these morbidities, as a consequence of adult hemoglobin releasing non-physiological quantities of O2 to developing tissues. In 2009, we instituted a concerted effort to diminish Erythrocyte Transfusions in our NICU, and in 2013 we performed a before vs. after practice change analysis of the incidence of BPD, ROP and NEC during the 8-year period spanning this change. The Transfusion rate fell from a high of 14.8% of admissions in 2007 to a low of 6.3% in 2011 (p
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more clearly defining the risks of Erythrocyte Transfusion in the nicu
Journal of Maternal-fetal & Neonatal Medicine, 2012Co-Authors: Robert D Christensen, Antonio Del Vecchio, Sarah J. IlstrupAbstract: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,...
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Recent advances toward defining the benefits and risks of Erythrocyte Transfusions in neonates.
Archives of Disease in Childhood, 2012Co-Authors: Robert D Christensen, Sarah J. IlstrupAbstract:Like many treatments available to small or ill neonates, Erythrocyte Transfusions carry both benefi ts and risks. This review examines recent publications aimed at better defi ning those benefi ts and those risks, as means of advancing evidence-based neonatal intensive care unit Transfusion practices. Since decisions regarding whether to not to order an Erythrocyte Transfusion are based, in part, on the neonate’s blood haemoglobin concentration, the authors also review recent studies aimed at preventing the haemoglobin from falling to a point where a Transfusion is considered.
T L Warwood - One of the best experts on this subject based on the ideXlab platform.
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Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
Journal of Perinatology, 2011Co-Authors: T L Warwood, Diane K. Lambert, Erick Henry, Robert D ChristensenAbstract:Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
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very low birth weight infants qualifying for a late Erythrocyte Transfusion does giving darbepoetin along with the Transfusion counteract the Transfusion s erythropoietic suppression
Journal of Perinatology, 2011Co-Authors: Robert D Christensen, T L Warwood, Diane K. Lambert, Erick HenryAbstract:Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
Erick Henry - One of the best experts on this subject based on the ideXlab platform.
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instituting a program to reduce the Erythrocyte Transfusion rate was accompanied by reductions in the incidence of bronchopulmonary dysplasia retinopathy of prematurity and necrotizing enterocolitis
Journal of Maternal-fetal & Neonatal Medicine, 2013Co-Authors: Del Vecchio A, Erick Henry, G Damato, A Cannuscio, L Corriero, M Motta, Robert D ChristensenAbstract:AbstractBronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) all likely involve oxidative damage to immature tissues. It has been postulated that Transfusions of adult Erythrocytes contribute to the risk of developing these morbidities, as a consequence of adult hemoglobin releasing non-physiological quantities of O2 to developing tissues. In 2009, we instituted a concerted effort to diminish Erythrocyte Transfusions in our NICU, and in 2013 we performed a before vs. after practice change analysis of the incidence of BPD, ROP and NEC during the 8-year period spanning this change. The Transfusion rate fell from a high of 14.8% of admissions in 2007 to a low of 6.3% in 2011 (p < 0.001). Concordant with this reduction patients had a lower incidence of; BPD (from 3.2% to 0.9%; OR, 3.722; CI 1.897–7.302), ROP (from 4.6% to 2.4%; OR 1.958, CI 1.247–3.073), and a trend toward less NEC (from 0.7% to 0.2%; OR 3.090, CI 0.835–11.443).
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Instituting a program to reduce the Erythrocyte Transfusion rate was accompanied by reductions in the incidence of bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis
Journal of Maternal-fetal & Neonatal Medicine, 2013Co-Authors: Del Vecchio A, Erick Henry, M Motta, D'amato G, Cannuscio A, Corriero L, Robert D ChristensenAbstract:AbstractBronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) all likely involve oxidative damage to immature tissues. It has been postulated that Transfusions of adult Erythrocytes contribute to the risk of developing these morbidities, as a consequence of adult hemoglobin releasing non-physiological quantities of O2 to developing tissues. In 2009, we instituted a concerted effort to diminish Erythrocyte Transfusions in our NICU, and in 2013 we performed a before vs. after practice change analysis of the incidence of BPD, ROP and NEC during the 8-year period spanning this change. The Transfusion rate fell from a high of 14.8% of admissions in 2007 to a low of 6.3% in 2011 (p
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Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
Journal of Perinatology, 2011Co-Authors: T L Warwood, Diane K. Lambert, Erick Henry, Robert D ChristensenAbstract:Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
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very low birth weight infants qualifying for a late Erythrocyte Transfusion does giving darbepoetin along with the Transfusion counteract the Transfusion s erythropoietic suppression
Journal of Perinatology, 2011Co-Authors: Robert D Christensen, T L Warwood, Diane K. Lambert, Erick HenryAbstract:Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
Diane K. Lambert - One of the best experts on this subject based on the ideXlab platform.
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neonates results in higher hemoglobin and fewer RBC Transfusions
2020Co-Authors: Vickie L. Baer, Diane K. Lambert, Patrick D. Carroll, Erick Gerday, Robert D ChristensenAbstract:OBJECTIVE: We previously described a method for reducing early phlebotomy losses from very low birth weight (VLBW) neonates by obtaining the initial blood tests from otherwise discarded fetal blood from the placenta. In the present study we sought to; (1) measure the feasibility of performing this method in actual practice, (2) test the hypothesis that this method would result in higher hemoglobin concentrations and lower Erythrocyte Transfusion rates in the first week after birth. METHODS: We conducted two studies in three Intermountain Healthcare NICUs. The first was a feasibility analysis involving 96 VLBW neonates, measuring the success of obtaining the NICU admission laboratory blood tests this way. The second study used case–control methodology to test the hypothesis that this method would result in a higher blood hemoglobin 12 to 24 h after birth, and a lower proportion receiving an Erythrocyte Transfusion in the first week. RESULT: In 91 of 96 VLBW neonates (95%) the initial blood tests were successfully obtained with this method. The success rate was not diminished by delayed cord clamping or cord milking, as it was successful in 35 of 36 (97%) such instances. Cases and controls were well matched on demographic and level of illness comparisons. Among cases the hemoglobin generally increased between birth and 12 to 24 h later, but among controls the hemoglobin generally decreased (Po0.05). In the week following birth fewer cases received vasopressors (Po0.01) and Erythrocyte Transfusions (Po0.001). CONCLUSION: We judge that it is feasible to collect the initial blood tests of VLBW neonates using otherwise discarded umbilical cord/placental blood, in that this can be accomplished in about 95% of VLBW deliveries. This method, which can be used in addition to either delayed clamping of the umbilical cord or cord milking, results in higher hemoglobin concentrations, less vasopressor use and fewer Transfusions in the first week.
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Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
Journal of Perinatology, 2011Co-Authors: T L Warwood, Diane K. Lambert, Erick Henry, Robert D ChristensenAbstract:Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
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very low birth weight infants qualifying for a late Erythrocyte Transfusion does giving darbepoetin along with the Transfusion counteract the Transfusion s erythropoietic suppression
Journal of Perinatology, 2011Co-Authors: Robert D Christensen, T L Warwood, Diane K. Lambert, Erick HenryAbstract:Very low birth weight infants qualifying for a ‘late’ Erythrocyte Transfusion: Does giving darbepoetin along with the Transfusion counteract the Transfusion's erythropoietic suppression?
Milo Engoren - One of the best experts on this subject based on the ideXlab platform.
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does Erythrocyte blood Transfusion prevent acute kidney injury propensity matched case control analysis
Anesthesiology, 2010Co-Authors: Milo EngorenAbstract:Background: Acute kidney injury is a common occurrence in intensive care unit patients with a reported incidence of 11-67% and is associated with an increased risk of death. In other patient populations, Erythrocyte Transfusion has been associated with increased risk of adverse outcomes including sepsis, multisystem organ dysfunction, and death. The purpose of this study was to determine the effect of Erythrocyte Transfusion on the development of acute kidney injury. Methods: This was a retrospective analysis of prospectively collected data that used propensity matched transfused and nontransfused patients. Propensity matching was done using semiparsimonious logistic regression. McNemar test for nonindependent data sets was used to compare groups. Results: Four hundred two patients from a trial on fluid management in patients with acute lung injury were matched. 38% of transfused patients had a rise in creatinine the day after Transfusion compared with 33% of their nontransfused matches (P = 0.315). By day 7, creatinine had increased in 51% of transfused patients compared with 52% in nontransfused patients (P = 0.832). The incidences of renal risk, injury, and failure were 39 (19%), 27 (13%), and 11 (5%) in the transfused group and 38 (19%), 24 (12%), and 11 (5%) in the nontransfused group, P = 1.00, 0.785, and 1.00, respectively. Conclusions: Transfusion of Erythrocytes to patients with acute lung injury had no effect on the development of acute kidney injury.
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the effect on long term survival of Erythrocyte Transfusion given for cardiac valve operations
The Annals of Thoracic Surgery, 2009Co-Authors: Milo Engoren, Robert H Habib, Jonathan Hadaway, Anoar Zacharias, Thomas A Schwann, Christopher J RiordanAbstract:Background Studies in patients undergoing coronary artery bypass grafting (CABG) have shown an increased long-term mortality rates associated with perioperative blood Transfusions. However, some studies in other patient populations have shown no effect on death or even a lowered mortality rate in patients receiving blood Transfusions, which suggests that the effects of blood Transfusion may be disease-dependent. Methods Data of all patients who underwent valve operations with or without associated CABG between October 2, 1991, and November 14, 2007, were obtained from the department's database and analyzed using logistic regression for 30-day and Cox models for long-term mortality to determine the effects of Transfusion on death. To control for the potential interaction between Transfusion and complications and sicker patients being more likely to receive blood, we separately analyzed the data for the different valve populations and used propensity analysis to control for sicker patients being more likely to receive blood. Results Of 1823 patients who underwent valve operations, the operation was isolated in 993 and combined with CABG in 830. By 30 days, 125 patients (6.9%) had died, and 717 (39%) were dead at follow-up. After controlling for type of operation and factors that influenced the Transfusion decision, Transfusion was associated with increased death only in patients who had combined valve and CABG, and not in isolated valve operations. Conclusions Transfusion had no effect on the mortality rate after isolated valve operations but was associated with increased mortality when valve operations were combined with CABG.