Perioperative transfusion and need for preoperative type and crossmatch in stable neonatal intensive care patients
*Olivia A. Kozel BA1, *Emily Hensler MD5, *Debra Watson-Smith BSN, RN2, *Mara Coyle MD3, Elizabeth Renaud MD, FACS, FAAP4
1The Warren Alpert Medical School of Brown University, Providence, RI; 2Pediatric Surgery, Brown Surgical Associates, Providence, RI; 3Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI; 4Pediatric Surgery, Hasbro Children's Hospital, Providence, RI; 5Surgery, Rhode Island Hospital, Providence, RI
Background: Neonates in intensive care settings commonly experience iatrogenic bloodloss due to frequent blood draws which when superimposed on anemias secondary to prematurity and critical illness can necessitate transfusion. Strategically limiting blood sampling can reduce the risk of iatrogenically worsening anemia. Type and crossmatch are routinely performed for neonates undergoing surgical procedures, including lower risk operations such as hernia repair or gastrostomy tube placement. Our aim was to determine the need for preoperative phlebotomy based on the frequency of perioperative blood transfusion in stable neonatal intensive care (NICU) patients undergoing lower risk procedures. Study Design: NICU patients (n=333) undergoing hernia repair or gastrostomy tube placement from 12/1/2010 through 11/30/2021 at a single institution were evaluated for factors associated with the need for perioperative transfusion. After IRB approval, charts were retrospectively reviewed for weight, gestational age at birth, corrected age at operation, comorbidities, perioperative lab work, surgical outcomes, and need for transfusion. Data were analyzed using Chi-square analysis/Fisher’s Exact test, ANOVA, or logistic regression for the appropriate variable types with p<0.05 as the threshold for significance. Results: The overall rate of perioperative transfusion in our study population was 4.8%. Need for transfusion was not associated with comorbid conditions (including neurologic, cardiac, pulmonary, gastrointestinal, or hematologic), need for preoperative respiratory support, gestational age at birth, birth weight, or type of surgery performed. Patients with a lower weight (<4 kg) at time of operation were more likely to require perioperative transfusion (OR 6.644, p=0.0462). Patients with lower preoperative hemoglobin (<10 g/dL) or hematocrit (<30%) were also more likely to require perioperative transfusion (OR 11.12 and 12.82 respectively, p-value <0.0001). Conclusions: Routine bloodwork is not needed for all NICU patients undergoing inguinal hernia repair or gastrostomy tube placement. However, patients weighing <4 kg at time of operation and those with lower preoperative hemoglobin or hematocrit may benefit from pre-operative type and cross.
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