64 - Blood Product Transfusion Thresholds and Association with Neurodevelopmental Outcomes in Neonates with Hypoxic-Ischemic Encephalopathy

Poster Number: 64
Publication Number: 64.239

Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a devastating condition resulting in neurodevelopmental impairment, despite provision of therapeutic hypothermia (TH). Hematological abnormalities are common, but safe and neuroprotective transfusion practices are poorly understood.

Objective: This study aims to describe blood product transfusion practices in infants with HIE and understand whether there is an association between the severity of hematological abnormalities and resultant blood product transfusions with short- and long-term outcomes.

Design/Methods: This retrospective cohort study was conducted at a single level IV NICU in Toronto, Canada (The Hospital for Sick Children). All admitted neonates with HIE, born between 1 June 2018 and 31 December 2021, having undergone TH and received post-rewarming brain MRI were included in the study. The primary composite outcome was death or neurodevelopmental impairment (NDI). NDI was defined as a composite score of < 85 in any domain on Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) assessment at 18 months and/or cerebral palsy, as assessed by the Gross Motor Function Classification System (GMFCS). A two-fold analysis was carried out, evaluating the association between hematological abnormalities or blood product transfusions and outcomes.

Results: Of the total 301 infants, outcome data was available for 185 infants. Of 301 infants, 99 (33%) received at least one blood product transfusion during TH with FFP being the commonest transfusion type. The mean nadir value for Hgb was 141+/-29; for platelet count was 134+/-58; and for fibrinogen was 1.5 +/-0.7. The mean peak value of INR was 2.1+/-1.2 and PTT was 64.1+/-35. Multivariate analysis adjusting for HIE severity demonstrated no association between hematological abnormality (anemia, thrombocytopenia, coagulopathy) or blood product transfusion (Packed Red Blood Cell, Platelet, FFP, Cryoprecipitate) and the primary outcome of death or NDI. This finding was reflected for liberal transfusion thresholds (Hemoglobin 100, Platelet count 50, INR 2, PTT 50, Fibrinogen 2), as well as conservative transfusion thresholds (Hemoglobin 80, Platelet count 30, INR 3, PTT 60, Fibrinogen 1).

Conclusion(s): Infants with HIE commonly receive blood product transfusions, but the levels at which these products are administered are highly variable. In this study, we did not find an association between liberal or conservative transfusion practices and the outcomes of death or NDI. Future prospective studies are needed to establish safe and neuroprotective transfusion practices in this population.