1. For preterm infants with echocardiographically-confirmed patent ductus arteriosus (PDA) within the first 14 days of life, there was no significant difference in the timing of PDA closure between infants who received liberal versus restrictive platelet transfusions.
2. Infants in the liberal transfusion group had significantly higher rates of intraventricular hemorrhage (IVH) of any grade compared to the restrictive group. There was no significant difference between groups for IVH grade III-IV. The cumulative volume of platelet transfusion was a significant risk factor in developing any grade IVH.
Evidence Rating: Level 1 (Excellent)
Liberal platelet transfusion does not expedite patent ductus arterious closure
Study Rundown: Prospective data has supported a positive association between thrombocytopenia and PDA. One theory, based on animal studies, is that platelet accumulation within the PDA may lead to thrombus formulation and vascular remodeling, resulting in PDA closure. The purpose of this randomized controlled trial was to evaluate whether maintaining a platelet count of >100 000/uL in thrombocytopenic preterm infants with PDA identified in the first 14 days of life would result in the primary outcome of earlier PDA closure. Preterm infants with PDA were randomized into a “liberal” versus “restrictive” platelet transfusion group. Researchers found no statistically significant difference between groups for time to closure of the PDA. Significant secondary outcomes included higher volume of platelets transfused and higher rates of any grade IVH in the liberal group. However, there was no difference between groups for IVH grades III-IV. Follow-up analyses showed that cumulative volume of platelets received was a significant risk factor for any grade IVH. This study is limited by an inability to account for potential platelet dysfunction, which may explain why groups had similar outcomes. For neonatologists, these data suggest that liberal use of platelets in preterm infants with PDAs in the first 14 days of life will not increase time to closure and may increase risk of any grade of IVH.
