Medical Dialogues
  • Dermatology
Sign in Signup
This site is intended for healthcare professionals only
Sign in Signup
  • Medical Jobs
  • Medical Matrimony
  • MD Brand Connect
  • MDTV
Medical Dialogues
  • Medical News
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • MCI News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Medical Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Aborad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
  • MDTV
      • Anesthesia
      • CTVS
      • Cardiology
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • Diet and nutrition
      • ENT
      • Gastroenterology
      • Health Dialogues
      • Health News today
      • Health Shorts
      • Health Updates
      • Health video of the day
      • Laboratory Medicine
      • Latest Videos
      • Latest Webinars
      • MD shorts
      • Medical News Today
      • Medical Updates
      • Medical Video of the day
      • Medicine
      • Nephrology
      • Neurology and Neurosurgery
      • Obstetrics and Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics & Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Top Videos
      • Urology
This site is intended for healthcare professionals only
Sign InRegister
Medical Dialogues
Sign inRegister
  • Home
  • Medical news
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • MCI News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Medical Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Aborad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
  • Case of the Day
  • Editorial
  • Home
  • Pediatrics and Neonatology
  • Pediatrics and Neonatology News
  • Red blood cell...

Red blood cell transfusions can increase mortality rates of newborns on ECMO, study finds

Hina ZahidBy Hina ZahidPublished On 2022-02-17T09:00:15+05:30  |  Updated On 2022-02-17T09:00:36+05:30
Red blood cell transfusions can increase mortality rates of newborns on ECMO, study finds

AUGUSTA, Ga. - Newborns in respiratory failure who require the life-sustaining support of ECMO also require transfusion of red blood cells. But a new study indicates that the higher volume of these oxygen-carrying blood cells the babies receive, the higher their mortality rate."In order for the baby to survive on ECMO, they need red blood cells, they need platelets, they need plasma," says...

AUGUSTA, Ga. - Newborns in respiratory failure who require the life-sustaining support of ECMO also require transfusion of red blood cells. But a new study indicates that the higher volume of these oxygen-carrying blood cells the babies receive, the higher their mortality rate.

"In order for the baby to survive on ECMO, they need red blood cells, they need platelets, they need plasma," says Dr. Brian Stansfield, neonatologist at the Medical College of Georgia and Children's Hospital of Georgia and vice chair for research in the MCG Department of Pediatrics. "You have to have sufficient blood volume to make the whole system work. But there is also increasing evidence that if you can get by with less, that is probably more."

"We think this supports the overall trend of being more restrictive in transfusion practices and being even more mindful about when you give transfusions and when you don't while a child is on ECMO," says Dr. Jessica Gancar, neonatology fellow at MCG and CHOG.

The physicians are not certain their findings would hold in all populations of newborns who need ECMO, but feel confident it does for babies in respiratory failure, the largest population of newborns who are placed on this external circuit that can take over the work of the lungs, or the heart and lungs, for a matter of days until the problem, such as waste material aspirated into the lungs during delivery, clears or is corrected by surgery.

They say the findings also are another good reason for ECMO centers to reexamine when they transfuse babies.

Hematocrit levels, the ratio of red blood cells to total blood volume, are a key measure typically used to determine whether to transfuse.

"Our transfusion practice is when the hematocrit hits 35% we will transfuse," says Stansfield. "Most ECMO centers still have a threshold of 40%, which means they are transfusing more. Others transfuse at 30%. So in our program we also have to ask the question if we are accepting some unnecessary risks. Could we get by with less?"

They looked at a large, homogeneous group of newborns treated with ECMO at a single institution for respiratory failure. All told they looked at 248 newborns treated from 2002-19 at CHOG with an overall survival rate of 93%.

They looked at their medical records and predicted mortality risk based on a risk assessment for babies requiring ECMO called Neo-RESCUERS, for any relationship between blood product transfusion — including the primary component of red blood cells as well as, plasma which gives the blood volume, and platelets that enable clotting — and death and complication rates in these babies.

"We identified a clear linear relationship between mortality and red blood cell transfusion volume. Specifically, for every transfusion of red cells while on ECMO, a baby's chances of survival decreased by 14%," Gancar says.

They found no correlation between increased mortality and plasma or platelet transfusions.

Gancar is presenting the findings during the Southern Society for Pediatric Research meeting Feb. 13-15 in New Orleans.

While blood product transfusions are necessary for critically ill newborns on ECMO, transfusions are given in response to "understudied, arbitrary thresholds and may be associated with significant morbidity and mortality," they write in their abstract.

"I think we are getting to the point, with neonatal ECMO in particular, where we are transitioning from how do we prevent death by intervening with ECMO — for a long time that was the question — to asking questions like once you are on ECMO, how do we make outcomes better," Stansfield says.

"We already know that going on ECMO is a risk, that all the blood and other products we are giving at the start of ECMO is a risk, but could we limit some of the additional risk?" he says.

Because blood is moving from baby to machine to be cleaned and oxygenated then back to baby, ECMO requires essentially doubling the baby's blood volume, Gancar says. Just priming the pump typically requires two packs of red blood cells along with other select additives like albumin, the most abundant protein in plasma which helps transport substances like hormones in the blood, and the blood thinner heparin. Typically two more packs of platelets as well as fresh frozen plasma are given once the baby is on ECMO. Other blood product transfusions may follow over their course on ECMO, which averages three to seven days at CHOG.

At CHOG, the neonatal specialists work hard to give as few transfusions as possible and some babies, typically those on ECMO five days or less, may not require any exposures beyond the pump priming; others, typically the sickest babies, may be given five to 10 transfusions over their treatment course. They note that their study adjusted for sickness severity so that could not explain the increased mortality they found associated with more red blood cell transfusions.

It's known that a blood transfusion, while lifesaving in many scenarios, also increases mortality risk in essentially any disease process, Gancar says, as they can prompt problems like increased inflammation, despite modern typing procedures to help ensure a good match between donor and recipient.

"It's been shown for a long period of time that more transfusions equal more death,' Stansfield adds, and in these babies that risk seems uniquely associated with red blood cells, which have to be separated from factors they normally circulate with, be exposed to preservatives and may have a protracted storage time before they are transfused.

Decades of success with ECMO has the CHOG team confident about its value in helping babies overcome potentially deadly but also potentially reversible problems like meconium aspiration, but they still have a "healthy respect" for the technique, Stansfield says.

They rule out traditional therapies first like using a ventilator to support breathing and the gas nitric oxide to dilate the lungs and blood vessels. Stansfield notes that the number of babies who need ECMO has decreased over the years as neonatal teams like theirs have gotten better at these other strategies.

But sometimes: "We run out of options unfortunately and that is when we bring in ECMO," says Stansfield. While the team has one of the longest and best track records in the nation with ECMO, the facts remain that it requires surgery on the baby's neck to place a small cannula in their internal jugular vein and sometimes a second one placed in the carotid artery to return the warmed and oxygenated blood back to the baby. Both those blood vessels no longer function afterward.

Approaches like ventilators are more straightforward and less invasive, Stansfield says. "But the realization is that we know there is a small percentage of kids that need more intensive therapy," he says.

CHOG had the first ECMO program in the Southeast and one of the first half dozen programs in the nation. MCG faculty used ECMO for the first time on a baby at CHOG March 16, 1985.

Respiratory failure includes meconium aspiration, when a baby gets stressed in utero and releases waste product which can clog their airway when he or she tries to breathe on their own, and persistent pulmonary hypertension when the baby's lungs don't adequately take over the fundamental of providing oxygen at the moment of birth.

"The transition from the mother breathing for the baby to the baby breathing for itself does not happen right," says Stansfield. "Any sort of delay as you can imagine would be detrimental."

Another top cause for using ECMO is a congenital diaphragmatic hernia, a birth defect which leaves the diaphragm, a big muscle that helps pull air into the lungs, with a hole that enables organs like the liver and stomach to move up into the baby's chest. In this case, ECMO, is a temporizing measure until the baby can have surgery to repair the defect.


southern society for pediatric research blood cell transfusions newborns 
Source : Southern Society for Pediatric Research
Hina Zahid
Hina Zahid

    Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email: editorial@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story
    Similar Posts
    NO DATA FOUND

    Editorial

    Review: Efficacy of Antiviral Agents Against  Omicron Subvariant BA.2

    Review: Efficacy of Antiviral Agents Against Omicron Subvariant BA.2

    Choice of Antibiotics in Common Infections: Doxycycline or Azithromycin?

    Choice of Antibiotics in Common Infections: Doxycycline or Azithromycin?

    Role of acyclovir in Management of chickenpox: Analyzing the importance of starting early

    Role of acyclovir in Management of chickenpox: Analyzing the importance of starting early

    Parkinsonism and the place of Amantadine - Review Analysis

    Parkinsonism and the place of Amantadine - Review Analysis

    When to Introduce time tested drug Amlodipine to manage Hypertension?

    When to Introduce time tested drug Amlodipine to manage Hypertension?

    View All

    Journal Club Today

    Kids on vegetarian diet are no diiferent than children who eat meat

    Kids on vegetarian diet are no diiferent than children who eat meat

    View All

    Health News Today

    Health Bulletin 14/May/2022

    Health Bulletin 14/May/2022

    View All
    © 2019 All Rights Reserved.
    Powered By: Hocalwire
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok
    X
    X