Multicenter analysis of platelet transfusion usage among neonates on extracorporeal membrane oxygenation

Objective. Multiple platelet transfu- sions are invariably given to neonates on extracorporeal membrane oxygenation (ECMO), and no alternative to repeated transfusions exists. Before any alternatives, such as administration of thrombopoietic stimulators, could be contemplated, data regarding the number of platelet transfusions received by neonatal ECMO pa- tients is needed, and the mechanisms that cause the thrombocytopenia of these patients must be better de- fined. As a step toward determining this, we analyzed the use of platelet transfusions in this group of neonates. We conducted a historic cohort study of neonates who were treated with ECMO to determine the number of platelet units received as a function of 1) days on ECMO, 2) medical diagnosis for which ECMO was instituted, and 3) type of ECMO used (venovenous (VV) vs venoar- terial (VA)). Methods. We reviewed the hospital records of all ne- onates who were admitted to the neonatal intensive care units at Shands Children's Hospital, Arnold Palmer Hos- pital for Children and Women, and Tampa General Hos- pital and treated with ECMO between January 1, 1995, and June 30, 2000. Data were expressed as the number of platelet transfusions versus number of days on ECMO, diagnosis for which ECMO was instituted, and type of ECMO used. Results. Of the 234 ECMO patients, 81 were placed on VV, 138 were placed on VA, and 15 were converted from VV to VA. The average number of platelet transfusions received per day was 1.3 and varied by diagnosis and by type of ECMO. Neonates with meconium aspiration and sepsis required more platelet transfusions per day than neonates with other conditions. Infants who were con- verted from VV to VA required more transfusions per day (mean: 1.57) than did patients on VA (1.47) or VV (1.06). Conclusions. Platelet transfusions among neonates on ECMO are dependent of their medical diagnosis; they average 1.3 transfusions per day and are higher on VA than VV ECMO. Pediatrics 2002;109(6). URL: http://www. pediatrics.org/cgi/content/full/109/6/e89; neonates, extra- corporeal membrane oxygenation, platelet transfusions. ABBREVIATIONS. ECMO, extracorporeal membrane oxygen- ation; PPHN, persistent pulmonary hypertension; CDH, congeni- tal diaphragmatic hernia; MAS, meconium aspiration syndrome; RDS, respiratory distress syndrome; VV, venovenous; VA, veno- arterial.