Premature babies could have better chance of survival with less treatment, trial with 'major implications' finds

Giving fewer transfusions and only in the most severely platelet-deficient babies reduced deaths and serious bleeding

Premature babies are commonly born without sufficient platelets for clotting
Premature babies are commonly born without sufficient platelets for clotting

Premature babies could stand a better chance of survival thanks to a counterintuitive study with “major implications” for how doctors manage a condition that can cause severe bleeding.

A medical trial led by UK and Irish institutions into the best treatment for babies born before 37 weeks whose blood is severely deficient in platelets – a crucial part of clotting, found benefits from giving less treatment.

It discovered that giving fewer platelet transfusions, and only in the babies with the lowest platelet levels to begin with, could prevent death or serious bleeding in seven out of every 100 with the condition.

The result came as a surprise to the researchers and would not have been identified without parents agreeing to participate in spite of the uncertainties.

“The findings have major implications for how neonatologists use platelet transfusions for sick premature babies with low platelets,” said Professor Simon Stanworth, of the University of Oxford, who helped lead the study.

“We need to remember that platelet transfusions are biological products, and they do have risks.

“This study also raises questions about using prophylactic platelet transfusions routinely in other patient groups with very low platelets.”

Platelets are the cells that help the blood to clot and are often given to babies with low platelet counts and no signs of bleeding, to try to prevent bleeding (known as prophylactic platelet transfusions).

However, doctors did not know the correct platelet count at which they should start giving transfusions to these babies.

The research, published in the New England Journal of Medicine, describes the final results of the PlaNet-2/Matisse clinical study, which involved 43 paediatric and neonatal units in the UK, Ireland and the Netherlands over a six-year period.

A total of 660 premature babies with low platelet counts were involved, making it the largest such study to date.

Premature babies with a platelet count below 100 x 109 per litre (normal platelet counts are above 150) were identified, and their parents then counselled and consented about the trial.

Babies were allocated by chance when their platelet count fell below 50, into one of two groups.

One group received a platelet transfusion as their platelet count dropped below 50 (the high threshold study arm), while the other group received a platelet transfusion but only whenever their platelet count dropped below 25 (the low threshold study arm).

Unexpectedly, they found that giving more platelet transfusions to babies at the higher platelet count (the high threshold study arm) was associated with a worse outcome (mortality and major bleeding in the next 28 days), compared with only transfusing babies whose count had dropped lower.

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Dr Andrew Cox, consultant neonatologist at East Lancashire Hospitals NHS Trust, said: “We really appreciate the selflessness of parents who agree to enrol their unwell babies into clinical trials such as the PlaNet -2 trial.

“This trial has a clear outcome which will improve the care of sick premature babies in units across the country and overseas.

“We often see premature babies in our unit with low platelets, and the result of the PlaNet-2 trial will guide us in managing these babies more safely and effectively.

“Babies and their families beyond those who so generously took part in the trial will benefit, and it is likely that more premature babies will survive because of them.

“This is a wonderful legacy, for which all those who care for sick babies should be thankful.”

Additional reporting by PA

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