Impact of Reducing Early Blood Sampling on Transfusion Needs in Extremely Premature Neonates

A recent study investigated the impact of blood sampling stewardship on transfusion requirements among extremely premature infants. The study included infants born at less than 28 weeks of gestation and with a birth weight of less than 1000 grams, who were randomized into two groups: restricted sampling (RS) or conventional sampling (CS). The RS group received targeted interventions to reduce blood sampling volume and frequency using point-of-care testing methods during the first six weeks after birth, alongside early recombinant erythropoietin administration from day three of age.

Key observations from the study include:

• Enrollment of 102 infants with high adherence to the sampling protocol in 95% of cases.
• Significant reductions in sampling losses during the first six weeks in the RS group compared to the CS group.
• A notably lower rate of early postnatal red blood cell (RBC) transfusions in the RS group.
• A 55% reduction in the hazard of requiring a transfusion during neonatal intensive care unit (NICU) stay in the RS group.
• Similar rates of mortality and neonatal morbidities between the RS and CS groups.

This study underscores the importance of minimizing blood sampling losses in the early weeks after birth for extremely premature infants weighing less than 1000 grams. By reducing sampling-related stress on these vulnerable neonates, the need for early RBC transfusions can be significantly decreased, potentially improving overall outcomes in this high-risk population.

Balasubramanian H, Bhanushali M, Tripathi V, et al. Effect of Minimization of Early Blood Sampling Losses Among Extremely Premature Neonates: A Randomized Clinical Trial. The Journal of Pediatrics. 2024;269. DOI:https://doi.org/10.1016/j.jpeds.2024.114002