• Alexander Fuchs, Nicola Disma, Katalin Virág, Francis Ulmer, Walid Habre, Jurgen C de Graaff, Thomas Riva, and NECTARINE Group of the European Society of Anaesthesiology and Intensive Care Clinical Trial Network.
• From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (AF, TR), Unit for Research & Innovation in Anaesthesia, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy (ND, TR), Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, University of Geneva, Geneva (KV, WH), Department of Paediatrics, Section of Critical Care, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (FU), and Department of Anaesthesiology, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands (JCdG).
• Eur J Anaesthesiol. 2022 Mar 1; 39 (3): 252260252-260.

BackgroundLittle is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards.ObjectiveTo observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome.DesignA multicentre observational study.SettingThe NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017.PatientsThe data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion.Main Outcome MeasuresThe primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality.ResultsPeri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%.ConclusionsResults indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies.Trial RegistrationClinicalTrials.gov, identifier: NCT02350348.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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