Platelet transfusions in the neonatal intensive care unit: factors predicting which patients will require multiple transfusions

BACKGROUND: Previous studies suggest that recombinant thrombopoietin (rTPO) will increase platelet production in thrombocytopenic neonates. However, t he target populations of neonates most likely to benefit should be defined. Studies suggest that rTPO will not elevate the platelet count until 5 days after the start of treatment. Therefore; the neonates who might benefit fr om rTPO are those who will require multiple platelet transfusions for more than 5 days. This study was designed to find means of prospectively identif ying these patients. STUDY DESIGN AND METHODS: A historic cohort study of all patients in the ne onatal intensive care unit (NICU) at the University of Florida who received platelet transfusions from January 1, 1997, through December 31, 1998, was conducted. RESULTS: Of the 1389 patients admitted to the NICU during the study period, 131 (9.4%) received platelet transfusions. Seventeen were treated with ext racorporeal membrane oxygenation and were excluded from further analysis. O f the remaining 114 patients, 55 (48%) received one transfusion and 59 (52% ) received more than one transfusion (21 had >4). None of the demographic f actors examined predicted multiple platelet transfusions. However, two clin ical conditions did; liver disease and renal insufficiency Neonates who rec eived one platelet transfusion had a relative risk of death 10.4 times that in neonates who received none (p = 0.0001). Neonates who received >4 plate let transfusions had a risk of death 29.9 times that in those who received no transfusions (p = 0.0001). CONCLUSION: NICU patients with liver disease or renal insufficiency who rec eive one platelet transfusion are likely to receive additional transfusions . Therefore, these patients constitute a possible study population for a Ph ase I/II rTPO trial.