Categorization and Frequency of Indications for Packed Cell Transfusion in the Preterm Newborn during the Initial Hospital Stay at a Tertiary Care Hospital: A Cross-Sectional Study

Introduction: Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies who are born at term. Complications related to prematurity increase as gestational age decreases and anemia is one of the complications of prematurity which needs packed cell transfusions. To date, when to transfuse preterm babies and what would be the threshold for hemoglobin and hematocrit is still a point of argument as well as liberal versus restrictive transfusion protocols have been developed but what should be followed still needs more data. In our study, we have observed frequencies of different indications of packed cell transfusion in the neonatal intensive care unit of a tertiary care hospital. This endeavor will help in the establishment of guidelines regarding transfusion and the threshold on which any intervention should be done also it would be a step towards the identification of preventable causes that lead to transfusion and transfusion-related risks and hazards. Objective: To determine the indication of packed cell transfusion and their frequencies in preterm neonates. Study Design: This was a cross-sectional study. Setting: The study was carried out in the neonatal intensive care unit (NICU). Study Duration: The duration of the study was 1 year. Material and Methods: A total of 246 preterm neonates admitted to Aga Khan University Hospital (AKUH) neonatal intensive care unit in the tenure of 1 year, fulfilling the inclusion criteria and requiring packed cell transfusion were included. After the approval from ethical review committee, charts were reviewed for gestational age, birth weight, mode of delivery (normal vaginal or Cesarean-section) were recorded. Indications of packed cell transfusion (intraventricular hemorrhage, infection or sepsis, anemia of prematurity, phlebotomy losses, increase oxygen requirement, hematological causes, other causes of hemorrhage and other causes) were observed and recorded. Pre-transfusion hemoglobin levels (g/dL) and hematocrit levels were also recorded. Other information like number and volume of transfusion and day of life on which transfusion was administered was also documented. Results: A total of 246 critically ill children were enrolled in this study. Of the total, 52.8% were baby boys and 47.2% were baby girls. 57% of babies were born via cesarean section and 43% were born via vaginal delivery. Out of total preterm newborns admitted in NICU, 22.8% were extremely preterm, 35.4% were very preterm and 41.9% were late preterm. Mean gestational age was observed to be 31 (±4) weeks and the mean birth weight of newborns was 1500 (±600) grams. Indications of packed cell transfusion observed in our study are intraventricular hemorrhage 10%, 26% sepsis/infection, 4% hematological disorders, 12.8% anemia of prematurity, 25.2% was related to increase in oxygen requirement, 13% other hematological causes and 9.3% other causes. Conclusion: An increase in oxygen requirement and anemia of prematurity were the indications that were observed in the extremely preterm and very preterm groups. Sepsis and increase oxygen requirement are some of the major causes of transfusions observed in the late preterm group. Preventable indications can be one of the areas that can be worked on and will reduce the need for transfusion in preterm babies with subsequent prevention of transfusion-associated risks.

Effect of packed red blood cell transfusion on the prognosis of patients with upper gastrointestinal bleeding:a retrospective analysis of eICU-CRD v2.0 multicenter critically ill patients database

Background:The effects of packed red blood cell(PRBC)transfusion on the prognosis of patients with upper gastrointestinal bleeding(UGIB),particularly on the 30-day mortality rate,are unclear.This study aimed to determine the prognostic influence of PRBC transfusion in patients with UGIB with different hemoglobin(Hb)levels.Methods:The subjects in this study were selected from the Philips Electronic ICU Collaborative Research Database Version 2.0 multi-center critically ill patient database from January 2014 to December 2015.A total of 4689 patients were included in this study.The Hb levels were divided into 3 groups:Hb<6 g/dL(Group 1),6 g/dL≤Hb<8 g/dL(Group 2),and Hb≥8 g/dL(Group 3).Based on the ad-ministration of PRBC transfusion,each group was subdivided into PRBC and non-PRBC groups.Results:A total of 4689 patients were enrolled in the study,including 825,2195,and 1669 patients in Groups 1,2,and 3,respectively.Furthermore,the PRBC and non-PRBC groups consisted of 1847 and 2842 patients,respectively.There was no significant difference in the 30-day mortality rate between Group 1 and Group 2 or between the PRBC and non-PRBC subgroups.In Group 3,the 30-day mor-tality rate of patients who received transfusion was higher than that of patients who did not(13.29%vs 9.14%,P=0.029).For the PRBC group,the difference in 30-day mortality rate was not statistically significant among the 3 groups,whereas for the non-PRBC group,the 30-day mortality rate in Group 3 was the lowest,and there was a significant difference among the 3 groups(P=0.003).There was no significant difference in the subgroup analysis of bleeding at different sites and etiologies.Conclusion:Packed red blood cell transfusion does not improve prognosis or reduce mortality in patients with UGIB but may increase mortality in patients with Hb levels greater than 8 g/dL.

COVID-19: Africa’s Challenge and the Need for a Paradigm Shift on the Use of Ventilators

Background: The December 2019 Chinese epidemic of Corona Virus Disease [COVID-19], which erupted in Wuhan, South China, was declared a pandemic, by the World Health Organization [WHO], on 12th January 2020. The worldwide spread from China was rapid, but Africa was the last port-of-call. Her first diagnosed case was two months after China’s, on 14th February, 2020 in Egypt. The morbidity and mortality rates have, however, remained lower in Africa than in the developed world, and analysts believe that it was more of a temporary respite, since Africa’s poor health infrastructure will become her eventual albatross. Methodology: Data were collected on COVID-19 and records of the socio-economic capacity of Africa by accessing the relevant previous and current peer-reviewed publications from multiple search engines on internet. The data were, then, collated and comparatively analyzed. Results: The available data revealed that Africa had, mostly, the milder forms of COVID-19, and so, morbidity and mortality were low. Her shrinking elderly population and hot climate were believed to be contributory, but lately, as the pandemic spread, the role of these factors was not exactly predictive. Being low on healthcare infrastructure, Africa could tenaciously leverage on the supportive and preventive measures prescribed by WHO, while the world awaited a vaccine. The role of ventilators in the care of critically ill patients, also, came under scrutiny as some workers were questioning the underlying pathology, and advocating a paradigm shift from high-tech positive end expiratory pressure ventilation to plasmapheresis and packed cell transfusion. Conclusion: Africa faces a huge challenge with COVID-19, but the predicted heavy mortalities may be reduced by some local confounding factors, control of spread and re-focusing of critical care away from the expensive and unavailable ventilators.