Henry E, Christensen R D, Sheffield M J, Eggert L D, Carroll P D, Minton S D, Lambert D K, Ilstrup S J
The Women and Newborn's Clinical Program, Salt Lake City, UT, USA.
The Transfusion Medicine Program, Intermountain Healthcare, Salt Lake City, UT, USA.
J Perinatol. 2015 Feb;35(2):132-6. doi: 10.1038/jp.2014.171. Epub 2014 Sep 25.
To compare neonatal red blood cell (RBC) transfusion rates in four large Intermountain Healthcare NICUs, all of which adhere to the same RBC transfusion guidelines.
This retrospective analysis was part of a transfusion-management quality-improvement project. De-identified data included RBC transfusions, clinical and laboratory findings, the anemia-prevention strategies in place in each NICU, and specific costs and outcomes.
Of 2389 NICU RBC transfusions given during the 4-year period studied, 98.9 ± 2.1% (mean ± S.D.) were compliant with our transfusion guidelines, with no difference in compliance between any of the four NICUs. However, RBC transfusion rates varied widely between the four, with averages ranging from 4.6 transfusions/1000 NICU days to 21.7/1000 NICU days (P < 0.00001). Gestational age-adjusted transfusion rates were correspondingly discordant (P < 0.00001). The lower-transfusing NICUs had written anemia-preventing guidelines, such as umbilical cord milking at very low birth weight delivery, use of cord blood for admission laboratory studies, and darbepoetin dosing for selected neonates. Rates of Bell stage ⩾ 2 necrotizing enterocolitis and grade ⩾ 3 intraventricular hemorrhage were lowest in the two lower-transfusing NICUs (P < 0.0002 and P < 0.0016). Average pharmacy costs for darbepoetin were $84/dose, with an average pharmacy cost of $269 per transfusion averted. With a cost of $900/RBC transfusion, the anemia-preventing strategies resulted in an estimated cost savings to Intermountain Healthcare of about $6970 per 1000 NICU days, or about $282,300 annually.
Using transfusion guidelines has been shown previously to reduce practice variability, lower transfusion rates and diminish transfusion costs. Based on our present findings, we maintain that even when transfusion guidelines are in place and adhered to rigorously, RBC transfusion rates are reduced further if anemia-preventing strategies are also in place.
比较山间医疗保健系统（Intermountain Healthcare）旗下四家大型新生儿重症监护病房（NICU）的新生儿红细胞（RBC）输注率，这四家病房均遵循相同的RBC输注指南。
这项回顾性分析是输血管理质量改进项目的一部分。去识别化的数据包括RBC输注情况、临床和实验室检查结果、各NICU实施的贫血预防策略以及具体的成本和结果。
在研究的4年期间进行的2389例NICU的RBC输注中，98.9±2.1%（均值±标准差）符合我们的输注指南，四家NICU之间的合规情况没有差异。然而，四家NICU的RBC输注率差异很大，平均值从每1000个NICU日4.6次输注到21.7次/1000个NICU日不等（P<0.00001）。根据胎龄调整后的输注率也相应不一致（P<0.00001）。输注率较低的NICU制定了书面的贫血预防指南，如在极低出生体重儿分娩时进行脐带挤血、使用脐带血进行入院实验室检查以及为选定的新生儿使用促红细胞生成素。在输注率较低的两家NICU中，Bell分期≥2期的坏死性小肠结肠炎和≥3级脑室内出血的发生率最低（P<0.0002和P<0.0016）。促红细胞生成素的平均药房成本为每剂84美元，每避免一次输血平均药房成本为269美元。每次RBC输血成本为900美元，这些贫血预防策略估计使山间医疗保健系统每1000个NICU日节省约6970美元，或每年约282,300美元。
先前已表明使用输血指南可减少实践差异、降低输血率并降低输血成本。基于我们目前的研究结果，我们认为即使有输血指南并严格遵守，如果同时实施贫血预防策略，RBC输注率会进一步降低。
