408 - Standardizing Platelet Transfusions in the Neonatal Period: A Performance Improvement Study

Poster Number: 408
Publication Number: 408.436

Johnna R. Mahoney, Thomas Jefferson University Hospital, Pennsauken Township, NJ, United States; Andrew Ellefson, Christiana Care Health System, Newark, DE, United States; David A. Paul, Sidney Kimmel Medical College at Thomas Jefferson University, Newark, DE, United States

Background: Up to 20-30% of neonates admitted to neonatal intensive care units are thrombocytopenic. Neonatal platelet transfusions are often given prophylactically to reduce the risk of bleeding, including intraventricular hemorrhage. Recent research has shown that a lower transfusion threshold for platelet transfusions is safe and does not increase risk of death or major bleeding.

Objective: The objective was to reduce out of guideline platelet transfusions in the NICU.

Design/Methods: Data were collected from all infants admitted to the Christiana Hospital NICU starting July 1 2018 to November 2021. Each platelet transfusion given in the NICU was examined to determine if it was within published guidelines. From 6/18-4/19 NICU guidelines included a high threshold for transfusion of 50k/mm3 and were modified in 4/19 based on the PlaNet-2 trial to include a threshold of 25k/mm3. Clinicians were provided education on transfusion guidelines and received feedback when transfusing out of guidelines. Rates of transfusion out of guidelines were compared before and after this change. Statistical process control charts for total transfusions and transfusions out of guideline were generated, and Chi Square and ANOVA were used to compare transfusions before and after change in guidelines; special cause variation was investigated to determine if implementation of guidelines has reduced overall transfusions and out of guideline transfusions. Balancing measures were incidences of severe IVH and other major bleeding.

Results: There was a decrease in the number of out of guideline transfusions per month after April 2019 (Figure). The percentage of transfusions out of guidelines decreased from 41% to 15% (p=0.047). There was no change in total number of platelet transfusions per month (p=0.35). The number of transfusions given per occurrence of platelet count < 100,000/mm3 also showed special cause variation reduction. No changes were observed over time in transfusions per count < 50,000/mm3. There were no changes noted in total admissions to the unit, admissions of patients < 32 weeks, admissions for therapeutic hypothermia, total occurrences of thrombocytopenia, or incidences of IVH over the study period.Conclusion(s): Our data show that implementing stricter platelet transfusion guidelines in a single NICU, along with education and feedback, reduced transfusions out of guidelines and transfusions per platelet count < 100,000/mm3 without any change in severe IVH. Platelet transfusions for count < 50,000/mm3 were not changed, indicating that further reductions may be achievable.
Johnna Mahoney CVMahoney CV December 2021.pdf