SCORE FOR NEONATAL ACUTE PHYSIOLOGY AND PHLEBOTOMY BLOOD-LOSS PREDICTERYTHROCYTE TRANSFUSIONS IN PREMATURE-INFANTS

Objective: To test the hypothesis that utilization of a previously des cribed measure of acuity tie, 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 transfusions dur ing the initial hospitalization.Design: Retrospective chart review. Se tting: A regional tertiary care newborn intensive care unit at the Ari zona Health Sciences Center, University Medical Center, Tucson. Materi als: Medical records of premature infants (birth weight, less than or equal to 1500 g) who were admitted from October 1993 to January 1995. Main Outcome Measures: Occurrence or nonoccurrence of erythrocyte tran sfusion was determined in 47 infants who were compared for demographic information, phlebotomy blood loss, diagnoses, medications, and the S NAP at 0, 1, 2, and 7 days of life. Results: Infants with a birth weig ht of 1500 g or less received a mean +/- SD of 1.9 +/- 2.9 transfusion s, with 22 (47%) of the infants given transfusions. Infants who were g iven transfusions vs those who were not given transfusions were of a l ower mean +/- SD birth weight (971 +/- 238 g vs 1272 +/- 144 g; P < .0 01) and a lower gestational age (27.7 +/- 1.6 weeks vs 30.7 +/- 2.8 we eks; 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 trans fusions were higher at 1, 2, and 7 days of life life (P = .03, P = .00 1, and P < .001, respectively). Using stepwise logistic regression, ph lebotomy blood loss and the SNAP at 7 days of life were significant pr edictors of the number of transfusions. The logistic model predicted w hich infants had been administered transfusions with 86% sensitivity a nd 88% specificity. Conclusions: The efficacy and cost-effectiveness o f recombinant human erythropoietin therapy in premature infants remain under study. As earlier treatment with recombinant human erythropoiet in may be more efficacious, early identification of which infants Curr ently undergo transfusion may identify those who will receive the grea test benefit from recombinant human erythropoietin therapy. The SNAP d istinguished those infants who were given transfusions from those who did not receive transfusions, even after adjusting for phlebotomy bloo d loss.