Supplementary Material for: Transfusion practices in 12 Neonatal Networks – Are we closer to adopting a restrictive transfusion approach?

Background:
Recent evidence suggests a restrictive approach towards blood transfusions for management of preterm infants.
Objective: To survey blood transfusion practises in preterm neonates <29 weeks’ gestation among 12 population-based neonatal-networks participating in the International Network for Evaluating Outcomes in Neonates (iNeo).

Design/Methods:
An online survey based on 2023 practices was sent to 608 neonatal intensive care units (NICU’s): Australia/New-Zealand (n= 30), Brazil (20), Canada (32), Finland (5), France (70), Israel (26), Japan (292), Poland (56), Spain (55), Sweden (9), Switzerland (9), and Tuscany, Italy (4). Transfusion thresholds in four different scenarios were surveyed: (a) infants invasively ventilated within first 7 postnatal days, (b) infants invasively ventilated after 7 days, (c) stable infants on non-invasive respiratory support, and (d) stable infants requiring no respiratory support.

Results:
A total of 382 NICU’s (63%) responded. Transfusion practices varied within networks and between countries. For invasively ventilated infants, the transfusion threshold during first 7 days after birth was a hematocrit ≤35% in 79% of NICUs, and at an age >8 days was a hematocrit ≤30% in 68% of NICU’s. For stable infants on non-invasive ventilation, the transfusion threshold was a hematocrit ≤30% in 80%, and in those without respiratory support, a hematocrit of ≤25% in 68% of NICU’s.

Conclusions:
Variations exist in blood transfusion practises between countries and within networks. A restrictive transfusion approach based on recent recommendations has been adopted by more than two-thirds of NICU’s. Additional research is needed to evaluate whether practices align with intentions and how they impact outcomes.

研究背景：近期研究证据显示，在早产新生儿的诊疗管理中，输血应采取限制性方案。
研究目的：针对参与新生儿结局评估国际网络（International Network for Evaluating Outcomes in Neonates，iNeo）的12个基于人群的新生儿医疗网络，调查胎龄小于29周的早产新生儿的输血临床实践现状。
设计与方法：本研究基于2023年临床实践开展一项线上调查，共向608家新生儿重症监护室（Neonatal Intensive Care Unit，NICU）发放问卷，覆盖地区及对应样本量分别为：澳大利亚/新西兰（30家）、巴西（20家）、加拿大（32家）、芬兰（5家）、法国（70家）、以色列（26家）、日本（292家）、波兰（56家）、西班牙（55家）、瑞典（9家）、瑞士（9家）以及意大利托斯卡纳地区（4家）。本次调查涵盖四种临床场景下的输血阈值：(a) 出生后7天内接受有创通气的早产儿；(b) 出生7天后接受有创通气的早产儿；(c) 接受无创呼吸支持的病情稳定早产儿；(d) 无需呼吸支持的病情稳定早产儿。
研究结果：共有382家NICU完成问卷回复，整体回收率为63%。不同医疗网络内部及国家间的输血实践存在显著差异。针对接受有创通气的早产儿，79%的NICU采用的出生后7天内输血阈值为血细胞比容≤35%，68%的NICU将出生8天后的输血阈值设定为血细胞比容≤30%。对于接受无创通气的病情稳定早产儿，80%的NICU采用的输血阈值为血细胞比容≤30%；而对于无需呼吸支持的病情稳定早产儿，68%的NICU输血阈值为血细胞比容≤25%。
研究结论：不同国家间及各医疗网络内部的输血实践仍存在差异。超过三分之二的NICU已基于近期临床指南采用限制性输血策略。未来仍需开展更多研究，以评估当前实践是否符合既定诊疗目标，以及该实践对新生儿结局的影响。