P1096 - Umbilical Cord Blood Use For Admission Blood Tests of VLBW Preterm Neonates: A Randomized Clinical Trial

Background: Very low birth weight (VLBW) premature neonates undergo phlebotomy procedures at time of admission to the neonatal intensive care unit (NICU). The volume of blood required for these tests can represent up to 10% of their total blood volume, increasing the likelihood of anemia requiring packed red blood cell (PRBC) transfusion. A strategy to decrease the risk of anemia includes the use of umbilical cord blood (UCB) for admission laboratory tests. To date, there have been no randomized clinical trials to investigate its use in VLBW infants.

Objective: To compare the use of UCB vs. infant blood as a strategy to decrease the risk of anemia requiring PRBC transfusion in VLBW infants.

Design/

Methods: This was a multicenter, prospective, randomized control trial at United States military NICUs. Infants less than 30 weeks gestational age or birth weight less than 1200 grams admitted to one of three participating NICUs were randomized via competitive enrollment across all sites. Infants randomized to the experimental arm had all admission labs drawn from UCB whereas labs for controls were drawn from the infant. The primary outcome was hemoglobin (HgB) concentration at 12-24 hours of life. Secondary outcomes include the number of PRBC transfusions, number of blood donor exposures, vasopressor use, presence of severe intraventricular hemorrhage (IVH), and HgB concentration changes at the 7th day of life.

Results: Data from 80 infants are presented. Admission characteristics between groups were not significantly different. Experimental infants’ HgB concentration at 12-24 hours were higher than control infants (15.5g/dL vs. 14g/dL, p=0.02) There was no significant difference in the HgB concentration at day of life 7. While there were no differences in the number of PRBC transfusions at 24 hours of life, infants in the experimental arm had fewer cases of severe IVH (32% vs. 11%, p=0.04) as well as donor exposures (1.1 vs. 1.8, p=0.04) during their hospital course. There was also a trend toward less vasopressor exposure in the first week of life (21% vs. 38%, p=0.08) as well as fewer number of transfusions (3.5 vs. 6.3, p=0.06) over their hospital course. Lastly, the median time to first transfusion was 7 days in controls compared with 24 days in the experimental arm.


Conclusions: Data suggest that the use of UCB for admission labs result in higher HgB concentrations in the first 24 hours of life at a period of higher risk for hemodynamic instability as well as delayed time to first transfusion.