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Inter-NICU Variation in Rates and Management of Thrombocytopenia among Very Low Birth-Weight Infants

Abstract

OBJECTIVES: To investigate variation among neonatal intensive care units (NICUs) in prevalence and management of thrombocytopenia in infants <1500 g.

STUDY DESIGN: In total 1283 infants <1500 g admitted to six NICUs over 21 months were prospectively analyzed. Illness severity was measured by the Score for Neonatal Acute Physiology (SNAP). Platelet counts in the first 12 hours after birth and on day 3 of life were abstracted from the infants' medical records. Thrombocytopenia was determined from the lowest platelet count in each of these time periods.

RESULTS: There was variability in rates of thrombocytopenia among NICUs, even after controlling for risk factors (e.g., SNAP, small for gestational (SGA) age and maternal hypertension). One site had a high prevalence of thrombocytopenia, but the lowest percentage of infants with thrombocytopenia who received platelet transfusions. After controlling for SNAP, GA, SGA, Apgar score and incidence of thrombocytopenia, the odds of receiving platelets at this site, relative to the site with the highest transfusion rate, was 0.10 (95% CI 0.02 to 0.43).

CONCLUSIONS: This multicenter study finds a 10-fold variation among NICU in the administration of platelets to their thrombocytopenic infants that cannot be explained by presence of thrombocytopenia or illness severity.

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Acknowledgements

We thank all of the co-investigators of the SNAP II Study Group at the participating sites, including: James E. Gray, MD, MS (Joint Program in Neonatology (Beth Israel, Brigham and Women's and Children's Hospital and Harvard Medical School), Boston, MA), Francis Bednarek, MD (Memorial Health Care and University of Massachusetts, Worcester, MA), Lewis P. Rubin, MD (Women and Infant's Hospital, Providence, RI), Bhavesh Shah, MD (Division of Neonatology, Baystate Medical Center, Springfield, MA), Ivan D. Frantz III, MD (Division of Newborn Medicine, Floating Hospital for Children at New England Medical Center, Boston), DeWayne Pursley, MD (Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA), Stuart Weisberger, MD (Memorial Health Care and University of MA, Worcester, MA), Marie McCormick, MD, ScD (Joint Program in Neonatology, Harvard Medical School and Department of Maternal and Child Health, Harvard School of Public Health, Boston, MA), Steve Gortmaker, PhD (Department of Health and Social Behavior, Harvard School of Public Health) and Donald Goldmann, MD (Division of Infectious Diseases, Children's Hospital, Boston, MA).

We also thank our project manager Trudy Brown Ripin, our analyst, Jeff Hansen, and our abstractors, Issa Al-Aweel, Michael Bradish, Gina Smithson-Compton, Rebecca James, Mary Naples, Jennifer Salzman and Rick Taranto.

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Kahn, D., Richardson, D. & Billett, H. Inter-NICU Variation in Rates and Management of Thrombocytopenia among Very Low Birth-Weight Infants. J Perinatol 23, 312–316 (2003). https://doi.org/10.1038/sj.jp.7210910

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