Scientific Letter
Transfusion practices of blood products in preterm infants: National survey
Prácticas transfusionales de hemoderivados en recién nacidos prematuros: encuesta nacional
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Los datos se expresan mediante diagramas de barras apiladas que muestran el porcentaje de unidades de neonatología que utilizan diferentes umbrales para la transfusión de CH en diferentes escenarios clínicos y semanas de vida. En la parte superior, los umbrales de referencia son los publicados en los ensayos clínicos ETTNO y TOP A): igual o menor al umbral restrictivo (verde), entre el restrictivo y el liberal (azul) y por encima del liberal (rojo); en la parte inferior los umbrales corresponden a las recomendaciones de la SENeo (B): igual o inferior al umbral (verde) y por encima del umbral (rojo). Los colores de la figura solo pueden apreciarse en la versión electrónica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Torrejón-Rodríguez, Alejandro Pinilla-González, Inmaculada Lara-Cantón, María Cernada, Alexandra Scrivens, Lisanne Heeger, Marta Aguar" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Torrejón-Rodríguez" ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Pinilla-González" ] 2 => array:2 [ "nombre" => "Inmaculada" "apellidos" => "Lara-Cantón" ] 3 => array:2 [ "nombre" => "María" "apellidos" => "Cernada" ] 4 => array:2 [ "nombre" => "Alexandra" "apellidos" => "Scrivens" ] 5 => array:2 [ "nombre" => "Lisanne" "apellidos" => "Heeger" ] 6 => array:2 [ "nombre" => "Marta" "apellidos" => "Aguar" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287923002223" "doi" => "10.1016/j.anpede.2023.07.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true 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"Heeger" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:4 [ "nombre" => "Marta" "apellidos" => "Aguar" "email" => array:1 [ 0 => "aguar_mar@gva.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Grupo Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Newborn Care Unit, Oxford University Hospitals NHS, Oxford, UK" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prácticas transfusionales de hemoderivados en recién nacidos prematuros: encuesta nacional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2420 "Ancho" => 3328 "Tamanyo" => 418775 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Current situation of PRBC transfusions in relation to the thresholds used in the ETTNO and TOP clinical trials (A) and the recommendations of the SENeo (B). Data presented in stacked bar charts showing the percentage of neonatal units that use different PRBC transfusion thresholds in different clinical scenarios and in infants with different gestational ages (weeks). In the charts at the top, the reference thresholds are those reported for the ETTNO and TOP trials: (A) at or below the restrictive (green), between the restrictive and liberal thresholds (blue) and above the liberal threshold (red). At the bottom, the thresholds correspond to the recommendations of the SENeo (B): at or below the threshold (green) and above the threshold (red). The colours of the figure can only be seen in the online version.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It is estimated that 90% of preterm newborns (PTIs) with birth weights of less than 1000 g receive at least one packed red blood cell (PRBC) transfusion and a smaller percentage platelets and/or fresh frozen plasma (FFP) transfusions. However, there is an obvious lack of scientific evidence in relation to the indications and benefits of transfusion practices in this subset of patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The recent Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants (ETTNO)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and Transfusion of Prematures (TOP)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> trials have demonstrated that the use of restrictive strategies in the PRBC transfusion is not inferior in terms of survival and neurocognitive outcomes to liberal strategies based on higher haemoglobin thresholds. With regard to platelets, the Platelets for Neonatal Thrombocytopenia (PlaNeT-2)/Management of Thrombocytopenia in Special Subgroup (MATISSE)<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> trial compared a liberal (50 000/dL) threshold for the indication of transfusion with a more restrictive one (25 000/dL), and found higher rates of death and major bleeding in the high-threshold group. These studies evinced the lack of knowledge of the pathophysiological processes underlying haematological disorders in PTIs.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In light of this situation, a European survey was carried out on the initiative of the Neonatal Transfusion Network, with participation of 343 centres in 18 countries.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In this framework, we carried out a substudy between December 2020 and April 2021 in level III neonatal units in Spain to assess the customary clinical practice in the use of blood products in PTI born at or before 32 weeks of gestation and analyse how it compares to the results of the most recent clinical trials and with the current overall situation in the Europe.</p><p id="par0020" class="elsevierStylePara elsevierViewall">To do so, we used an online that was sent to the main neonatal intensive care units across Spain. We contacted a total of 58 units, of which 41 (70%) responded. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the results regarding transfusion practices. In general, there was little variability between the surveyed facilities in the haemoglobin threshold used to determine the indication of transfusion support. The median PRBC volume delivered in Spanish hospitals was 15 mL/kg (interquartile range [IQR]: 15–20 mL/kg), the volume of platelets 15 mL/kg (IQR, 10–15 mL/kg) and the volume of FFP 15 mL/kg (IQR, 12.5–15 mL/kg). When it came to the indications for the administration of FFP, there was consensus in regard to its use for management of coagulopathy associated with bleeding. However, there were significant discrepancies between the surveyed centres in regard to other indications, such as coagulopathy without bleeding and bleeding in the absence of coagulopathy.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> compares the applied haemoglobin thresholds to the thresholds established in the trials mentioned above.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> We found that, on average, 13.3% of Spanish units applied restrictive thresholds, 83% intermediate thresholds and 3.5% liberal thresholds. In the European survey, up to 30% of the units applied restrictive thresholds, more than double the percentage in Spain, and 68% applied intermediate thresholds. Recently, the Standards Committee of the Sociedad Española de Neonatología (SENeo) published recommendations to standardise the transfusion of blood products in neonatal care nationwide.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> presents the comparison of real-world practice with the thresholds recommended by the SENeo, evincing good concordance with recommendations in the first two weeks of life, but the use of much more liberal thresholds after the second week.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">As regards the thresholds applied for the transfusion of platelets, in PTIs delivered before 28 weeks, 37% of the centres applied a restrictive threshold, a percentage that rose to 57% for PTIs delivered between 28 and 32 weeks. These results were similar to those of the European survey and in agreement with the recommendations derived from the findings of the PlaNeT2/MATISSE trial.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Based on our findings, we ought to highlight that Spanish neonatal units have more restrictive policies when it comes to platelet transfusion compared to the thresholds applied for the treatment of anaemia, which suggests an uneven application of scientific evidence to clinical practice. The most liberal transfusion policies beyond the first two weeks of life suggest a tendency to maintain the same transfusion thresholds established in the first weeks. In addition, there was substantial variability in the indications for FFP.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, our study evinced that transfusion policies diverged from recommendations in varying degrees. The fact that a large majority of hospitals used local protocols may be one of the factors contributing to the observed heterogeneity and hindering the application of the most recent evidence. These findings underscore the need to continue to promote research on transfusion, which will contribute to increase the quality and safety of the care provided to PTIs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2420 "Ancho" => 3328 "Tamanyo" => 418775 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Current situation of PRBC transfusions in relation to the thresholds used in the ETTNO and TOP clinical trials (A) and the recommendations of the SENeo (B). Data presented in stacked bar charts showing the percentage of neonatal units that use different PRBC transfusion thresholds in different clinical scenarios and in infants with different gestational ages (weeks). In the charts at the top, the reference thresholds are those reported for the ETTNO and TOP trials: (A) at or below the restrictive (green), between the restrictive and liberal thresholds (blue) and above the liberal threshold (red). At the bottom, the thresholds correspond to the recommendations of the SENeo (B): at or below the threshold (green) and above the threshold (red). The colours of the figure can only be seen in the online version.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The table presents the thresholds for packed red blood cells and platelet transfusion, expressed as median and interquartile range (IQR), for different clinical scenarios and gestational ages. It also includes information on the median volume administered and the median duration of transfusion, as well as the indications for fresh frozen plasma.</p>" "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Thresholds for transfusion of packed red blood cells in different clinical scenarios, median (IQR), expressed in g/dL</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><1 week \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1–2 weeks \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">>2 weeks \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No O<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 (8–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (7–8.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low-flow O<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (10–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (9–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 (8–9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O<span class="elsevierStyleInf">2</span> with FiO<span class="elsevierStyleInf">2</span> < 30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (11–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (10–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 (8–10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O<span class="elsevierStyleInf">2</span> with FiO<span class="elsevierStyleInf">2</span> > 30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (12–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (10–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (9.5–10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (10–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (10–11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Volume: 15 mL/kg (IQR, 15–20 mL/kg)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transfusion time: 3 h (IQR, 2–4 h)</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3354809.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Thresholds for platelet transfusion in different clinical scenarios (median, (IQR) expressed in platelets/dL)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><28 weeks \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">28–32 weeks \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 000 (20–50 × 10<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 000 (25–30 × 10<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 000 (50–100 × 10<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 000 (50–90 × 10<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Volume: 15 mL/kg (IQR, 10–15 mL/kg)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transfusion time: 2 h (IQR, 2–3 h)</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3354808.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indications for transfusion of fresh frozen plasma</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coagulopathy with bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coagulopathy without bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bleeding without coagulopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypotension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Volume: 15 mL/kg (IQR, 12.5–15 mL/kg)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of transfusion: 3 h (IQR, 3–4 h)</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3354810.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Data of the national survey of transfusion protocols.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ETTNO Investigators. Effects of liberal vs restrictive transfusion thresholds on survival and neurocognitive outcomes in extremely low-birth-weight infants: the ETTNO randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.R. Franz" 1 => "C. Engel" 2 => "D. Bassler" 3 => "M. Rüdiger" 4 => "U.H. Thome" 5 => "R.F. Maier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2020.10690" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2020" "volumen" => "324" "paginaInicial" => "560" "paginaFinal" => "570" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32780138" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eunice Kennedy Shriver NICHD Neonatal Research Network. Higher or lower hemoglobin transfusion thresholds for preterm infants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Kirpalani" 1 => "E.F. Bell" 2 => "S.R. Hintz" 3 => "S. Tan" 4 => "B. Schmidt" 5 => "A.S. Chaudhary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa2020248" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2020" "volumen" => "383" "paginaInicial" => "2639" "paginaFinal" => "2651" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33382931" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PlaNeT2 MATISSE Collaborators. Randomized trial of platelet-transfusion thresholds in neonates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Curley" 1 => "S.J. Stanworth" 2 => "K. Willoughby" 3 => "S.F. Fustolo-Gunnink" 4 => "V. Venkatesh" 5 => "C. Hudson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1807320" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2019" "volumen" => "380" "paginaInicial" => "242" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30387697" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survey of transfusion practices in preterm infants in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Scrivens" 1 => "N.J. Reibel" 2 => "L. Heeger" 3 => "S. Stanworth" 4 => "E. Lopriore" 5 => "H.V. New" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/archdischild-2022-324619" "Revista" => array:7 [ "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed" "fecha" => "2023" "volumen" => "108" "numero" => "4" "paginaInicial" => "360" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36653173" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "en representación del Comité de Estándares. Sociedad Española de Neonatología. Recommendations for transfusion of blood products in neonatology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Boix" 1 => "M.D. Sánchez-Redondo" 2 => "M. Cernada" 3 => "M.G.E. Fernández" 4 => "N. González-Pacheco" 5 => "A. Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anpede.2022.05.003" "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Engl Ed)" "fecha" => "2022" "volumen" => "97" "paginaInicial" => "60.e1" "paginaFinal" => "60.e8" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009900000005/v1_202311240521/S2341287923002223/v1_202311240521/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009900000005/v1_202311240521/S2341287923002223/v1_202311240521/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923002223?idApp=UINPBA00005H" ]
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