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Clinical Neonatal Transfusion Research

Introduction

Babies, in particular those born prematurely, are frequently transfused, but evidence for beneficial effects of these transfusions is limited. A recent prophylactic platelet transfusion randomized trial that we performed unexpectedly showed increased risk of major bleeding and death in babies receiving platelet transfusions at a higher platelet count threshold.

Several red cell transfusion trials have been published, but interpretation of these trials varies, and many clinically relevant questions remain unanswered. For plasma transfusion, evidence is especially scarce, with no large trials in the past decennium. The aim of our group is use clinical epidemiology as a tool to optimize transfusion practices for premature babies across the world, and to develop networks and collaborations to facilitate large scale studies, data sharing, and implementation projects. We are co-founders of the Neonatal Transfusion Network and collaborate closely with neonatologists, transfusion specialists, epidemiologists and hematologists from across the world.

Research lines:

  • Unraveling harmful effects of platelet transfusions on preterm infants
  • Identifying biomarkers that predict bleeding in preterm infants
  • Developing a clinical prediction model for bleeding in preterm infants, with the ultimate goal to develop a decision support tool. 
  • Developing a neonatal Patient Blood Management program, to reduce the need for red cell transfusions and support use of appropriate transfusion thresholds.
  • European Observational Point Prevalence Study to describe current transfusion practices (RBC, platelets, plasma) for preterm infants in Europe (19 participating countries). This study is performed by the Neonatal Transfusion Network.
     

Medical priorities: bleeding & hemostasis, anemia

Funding: European Society for Pediatric Research, European Blood Alliance, Sanquin Blood Supply Foundation.

Collaboration partners: www.neonataltransfusionnetwork.com.
Within Sanquin we collaborate within the Hemocure group (proteomics) within the medical priority Bleeding and Hemostasis, and the Pediatric Transfusion group (Karin Fijnvandraat, Elise Huisman). We collaborate with all Neonatal Intensive Care Units (NICU’s) in the Netherlands, in particular with Enrico Lopriore (professor of Neonatology, LUMC) and Wes Onland (MD, PhD, neonatologist Amsterdam UMC). We have close collaborations with researchers from Oxford University, NHSBT, Karolinska Intitute, Boston Children’s Hospital, and Charité Berlin. Our NTN network is endorsed by the European Society for Pediatric Research, the European Blood Alliance, the European Foundation for the Care of Newborn Infants and the International Hemovigilance Network. I am a member of the ISBT clinical transfusion - pediatric transfusion subgroup, chair of the European Society for Pediatric Research Special Interest group on Neonatal Hematology, and member of the European Society for Pediatric Research Section on Clinical Epidemiology.

Key publications:

Susanna F Fustolo-Gunnink, Karin Fijnvandraat, Hein Putter, Isabelle M Ree, Camila Caram-Deelder et al. Dynamic prediction of bleeding risk in thrombocytopenic preterm neonates. Haematologica. November 2019 104: 2300-2306.

Susanna F Fustolo-Gunnink, Karin Fijnvandraat, D. van Klaveren, S Stanworth, Anna Curley et al. Preterm neonates benefit from low prophylactic platelet transfusion threshold despite varying risk of bleeding or death. Blood. 2019 Dec 26;134(26):2354-2360.

Susanna F Fustolo-Gunnink, Roehr CC, Lieberman L, Christensen RD, Van Der Bom JG et al. Platelet and red cell transfusions for neonates: lifesavers or Trojan horses? Expert Rev Hematol. 2019 Oct;12(10):797-800

SF Fustolo-Gunnink, E.J. Huijssen-Huisman, K Fijnvandraat, F.M.A. van Hout, S. Makineli, E Lopriore, et al. Are platelet count and platelet transfusions associated with major bleeding in preterm neonates- A systematic review. Blood Reviews. 2019 Jul;36:1-9.

Anna Curley, Simon J Stanworth (joint first authors), Karen Willoughby, Susanna F Fustolo-Gunnink et al. A Randomized Trial of Neonatal Platelet Transfusion Thresholds. New England Journal of Medicine. 2018 Nov 2.