Score for neonatal acute physiology and phlebotomy blood loss predict erythrocyte transfusions in premature infants
P. J. Kling, T. M. Sullivan, M. E. Leftwich and D. J. Roe
Department of Pediatrics, Arizoma Health Sciences Center, Tucson, USA.
OBJECTIVE: To test the hypothesis that utilization of a previously
described measure of acuity (ie, the score for neonatal acute physiology
[SNAP]) during the first 7 postnatal days predicts which infants with a
birth weight of 1500 g or less received erythrocyte transfusion during the
initial hospitalization. DESIGN: Retrospective chart review. SETTING: A
regional tertiary care newborn intensive care unit at the Arizona Health
Sciences Center, University Medical Center, Tucson. MATERIALS: Medical
records of premature infants (birth weight, < or = 1500 g) who were
admitted from October 1993 to January 1995. MAIN OUTCOME MEASURES:
Occurrence or nonoccurrence of erythrocyte transfusion was determined in 47
infants who were compared for demographic information, phlebotomy blood
loss, diagnoses, medications, and the SNAP at 0, 1, 2, and 7 days of life.
RESULTS: Infants with a birth weight of 1500 g or less received a mean +/-
SD of 1.9 +/- 2.9 transfusions with 22 (47%) of the infants given
transfusions Infants who were given transfusions vs those who were not
given transfusions were of a lower mean +/- SD birth weight (971 +/- 238 g
vs 1272 +/- 144 g; P < .001) and a lower gestational age (27.7 +/- 1.6
weeks vs 30.7 +/- 2.8 weeks; P < .001), and they had a greater mean
phlebotomy blood loss (3.3 +/- 1.6 mL/kg per day vs 1.4 +/- 0.5 mL/kg per
day; P < .001) during the first postnatal week. The SNAP indexes in
those who received transfusions were higher at 1, 2, and 7 days of life (P
= .03, P = .001, and P < .001, respectively). Using stepwise logistic
regression, phlebotomy blood loss and the SNAP at 7 days of life were
significant predictors of the number of transfusions. The logistic model
predicted which infants had been administered transfusions with 86%
sensitivity and 88% specificity. CONCLUSIONS: The efficacy and
cost-effectiveness of recombinant human erythropoietin therapy in premature
infants remain under study. As earlier treatment with recombinant human
erythropoietin may be more efficacious, early identification of which
infants currently undergo transfusion may identify those who will receive
the greatest benefit from recombinant human erythropoietin therapy. The
SNAP distinguished those infants who were given transfusions from those who
did not receive transfusions, even after adjusting for phlebotomy blood
loss.
