Navegando por Palavras-chave "Transfusão de plaquetas"

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    Efetividade de um protocolo restrito para reduzir as indicações de transfusões de plaquetas em recém-nascidos pré-termo de muito baixo peso
    (Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Borges, Juliana Policastro Grassano [UNIFESP]; Santos, Amelia Miyashiro Nunes dos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Thrombocytopenia is frequent among preterm infants, but, in the absence of scientific evidence, platelet transfusions guidelines are currently based on expert opinions. Objective: To verify the effectiveness of a strict guideline to reduce platelet transfusions in very low birthweight preterm infants. Methods: Retrospective cohort of neonates with gestational age <37 weeks and birth weight <1500g born at Hospital São Paulo – Federal University of São Paulo. Infants were excluded if died within 24 hours of birth or no platelet count was performed during hospitalization. In Period 1 (Jan/02 to Apr/04) platelets transfusions were indicated in clinically stable neonates if platelets <50,000/mL and in bleeding or clinically unstable neonates if platelets count <100,000/mL. In Period 2 (May/04 to Dec/06) a strict guideline was developed and platelets transfusions were indicated for clinically stable preterm infants if the number of platelets was <25,000/mL; for neonates in mechanical ventilation with PWA >8cmH2O, on need of vasopressor drugs, before and within 5 days of any mayor surgery, before any invasive procedure, within 72 hours of a previous convulsive episode and in neonates with birth weight <1000g in the first week of life if platelets <50,000/mL; in bleeding neonates or before mayor surgeries if platelets <100,000/mL; Very low birth weight infants included in both periods were compared regarding demographic and clinical characteristics and need for platelets transfusions by t test, Mann-Whitney or c 2 test. Factors associated with platelets transfusions were compared by univariate and multiple logistic regression analysis, considering significant p<0.05. Results: During the studied period, 252 very low birth weight preterm infants were included, being 119 in Group 1 and 133 in Group 2. The two groups were similar regarding demographic and clinical characteristics, except by the frequency of sepsis and thrombocytopenia that were more frequent in Group 1. The frequency of periintraventricular hemorrhage, bleeding and intra-hospital death were similar between the two groups. Platelets transfusions were performed in 47 (30.5%) neonates of Group 1 and in 32 (24.1%) neonates of Group 2, p<0.001.The number of platelet transfusions per studied neonates was higher before the adoption of the strict guideline (Group 1: 2.4+5.1; Group 2: 1.6+4.3, p=0.021) and the number of platelet transfusions per infant transfused was similar in both periods (Group 1: 5.9+6.6, Group 2: 6.5+6.7, p=0.215). The mean number of platelets before transfusions was higher in Group 1 (35,234+30,000 vs. 26,999+14,184, p<0.001). The logistic regression analysis showed that the chance of receiving platelet transfusion was two times higher in neonates who were born before the implantation of the strict guideline, compared to those born after the adoption of this protocol. Conclusion: The strict guideline for platelet transfusions reduced the need for platelet transfusions without threatening the clinical course of very low birthweight preterm infants.