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Current Pediatric Reviews

Editor-in-Chief

ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

Review Article

Fresh Frozen Plasma Administration in the NICU: Evidence-based Guidelines

Author(s): Mario Motta* and Brunetta Guaragni

Volume 19, Issue 4, 2023

Published on: 22 December, 2022

Page: [342 - 351] Pages: 10

DOI: 10.2174/1573396319666221219153009

Price: $65

Open Access Journals Promotions 2
Abstract

The use of FFP in neonatology should be primarily for neonates with active bleeding and associated coagulopathy. However, since there is limited and poor-quality evidence supporting neonatal FFP transfusion, considerable FFP usage continues to be outside of this recommendation, as documented by neonatal transfusion audits. This review updates the scientific evidence available on FFP use in neonatology and reports the best evidence-practice for the safety of neonates receiving FFP.

Keywords: Fresh frozen plasma, transfusion, neonatology, coagulation tests, bleeding, neonate.

Graphical Abstract
[1]
Baer VL, Lambert DK, Schmutz N, et al. Adherence to NICU transfusion guidelines: Data from a multihospital healthcare system. J Perinatol 2008; 28(7): 492-7.
[http://dx.doi.org/10.1038/jp.2008.23] [PMID: 18337739]
[2]
Puetz J, Darling G, McCormick KA, Wofford JD. Fresh frozen plasma and recombinant factor VIIa use in neonates. J Pediatr Hematol Oncol 2009; 31(12): 901-6.
[http://dx.doi.org/10.1097/MPH.0b013e3181c29c25] [PMID: 19956022]
[3]
Altuntas N, Yenicesu İ, Beken S, et al. Clinical use of fresh-frozen plasma in neonatal intensive care unit. Transfus Apheresis Sci 2012; 47(1): 91-4.
[http://dx.doi.org/10.1016/j.transci.2012.05.007] [PMID: 22640835]
[4]
Stanworth SJ, Grant-Casey J, Lowe D, et al. The use of fresh-frozen plasma in England: High levels of inappropriate use in adults and children. Transfusion 2011; 51(1): 62-70.
[http://dx.doi.org/10.1111/j.1537-2995.2010.02798.x] [PMID: 20804532]
[5]
Puetz J, Witmer C, Huang YSV, Raffini L. Widespread use of fresh frozen plasma in US children’s hospitals despite limited evidence demonstrating a beneficial effect. J Pediatr 2012; 160(2): 210-215.e1.
[http://dx.doi.org/10.1016/j.jpeds.2011.08.013] [PMID: 21924435]
[6]
Motta M, Del Vecchio A, Perrone B, Ghirardello S, Radicioni M. Fresh frozen plasma use in the NICU: A prospective, observational, mul-ticentred study. Arch Dis Child Fetal Neonatal Ed 2014; 99(4): F303-8.
[http://dx.doi.org/10.1136/archdischild-2013-304747] [PMID: 24646616]
[7]
Houben NAM, Heeger LE, Stanworth SJ, et al. Changes in the use of fresh-frozen plasma transfusions in preterm neonates: A single cen-ter experience. J Clin Med 2020; 9(11): 3789.
[http://dx.doi.org/10.3390/jcm9113789] [PMID: 33238649]
[8]
Nellis ME, Saini A, Spinella PC, et al. Pediatric plasma and platelet transfusions on extracorporeal membrane oxygenation. Pediatr Crit Care Med 2020; 21(3): 267-75.
[http://dx.doi.org/10.1097/PCC.0000000000002160] [PMID: 31644453]
[9]
Bruun MT, Yazer MH, Spinella PC, et al. Vox Sanguinis International Forum on paediatric indications for blood component transfusion: Summary. Vox Sang. 114(5): 523-30.
[10]
Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 2004; 328(7454): 1490-4.
[http://dx.doi.org/10.1136/bmj.328.7454.1490] [PMID: 15205295]
[11]
Gross SJ, Filston HC, Anderson JC. Controlled study of treatment for disseminated intravascular coagulation in the neonate. J Pediatr 1982; 100(3): 445-8.
[http://dx.doi.org/10.1016/S0022-3476(82)80457-5] [PMID: 7038076]
[12]
Yuen P, Cheung A, Lin HJ, et al. Purpura fulminans in a Chinese boy with congenital protein C deficiency. Pediatrics 1986; 77(5): 670-6.
[http://dx.doi.org/10.1542/peds.77.5.670] [PMID: 3754634]
[13]
Branson H, Marble R, Katz J, Griffin J. Inherited protein C deficiency and coumarin-responsive chronic relapsing purpura fulminans in a newborn infant. Lancet 1983; 322(8360): 1165-8.
[http://dx.doi.org/10.1016/S0140-6736(83)91216-3] [PMID: 6139528]
[14]
Hambleton G, Appleyard WJ. Controlled trial of fresh frozen plasma in asphyxiated low birthweight infants. Arch Dis Child 1973; 48(1): 31-5.
[http://dx.doi.org/10.1136/adc.48.1.31] [PMID: 4685591]
[15]
Beverley DW, Pitts-Tucker TJ, Congdon PJ, Arthur RJ, Tate G. Prevention of intraventricular haemorrhage by fresh frozen plasma. Arch Dis Child 1985; 60(8): 710-3.
[http://dx.doi.org/10.1136/adc.60.8.710] [PMID: 3899020]
[16]
Ekblad H, Kero P, Shaffer SG, Korvenranta H. Extracellular volume in preterm infants: Influence of gestational age and colloids. Early Hum Dev 1991; 27(1-2): 1-7.
[http://dx.doi.org/10.1016/0378-3782(91)90022-U] [PMID: 1802656]
[17]
Elbourne D. A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose on early mortality and morbidity in preterm babies. Eur J Pediatr 1996; 155(7): 580-8.
[http://dx.doi.org/10.1007/BF01957909] [PMID: 8831082]
[18]
Osborn DA, Evans NJ. Early volume expansion for prevention of morbidity and mortality in very preterm infants. Cochrane Libr 2004; 2004(2) ,CD002055.
[http://dx.doi.org/10.1002/14651858.CD002055.pub2] [PMID: 15106166]
[19]
Randomised trial of prophylactic early fresh-frozen plasma or gelatin or glucose in preterm babies: outcome at 2 years. Lancet 1996; 348(9022): 229-32.
[http://dx.doi.org/10.1016/S0140-6736(95)12506-X] [PMID: 8684200]
[20]
Acunas BA, Peakman M, Liossis G, et al. Effect of fresh frozen plasma and gammaglobulin on humoral immunity in neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 1994; 70(3): F182-7.
[http://dx.doi.org/10.1136/fn.70.3.F182] [PMID: 8198411]
[21]
Krediet TG, Beurskens FJM, Van Dijk H, Gerards LJ, Fleer A. Antibody responses and opsonic activity in sera of preterm neonates with coagulase-negative staphylococcal septicemia and the effect of the administration of fresh frozen plasma. Pediatr Res 1998; 43(5): 645-51.
[http://dx.doi.org/10.1203/00006450-199805000-00013] [PMID: 9585011]
[22]
Gottuso MA, Williams ML, Oski FA. The role of exchange transfusions in the management of low-birth-weight infants with and without severe respiratory distress syndrome. J Pediatr 1976; 89(2): 279-85.
[http://dx.doi.org/10.1016/S0022-3476(76)80468-4] [PMID: 781206]
[23]
Emery EF, Greenough A, Gamsu HR. Randomised controlled trial of colloid infusions in hypotensive preterm infants. Arch Dis Child 1992; 67(10): 1185-8.
[http://dx.doi.org/10.1136/adc.67.10_Spec_No.1185]
[24]
Mou SS, Giroir BP, Molitor-Kirsch EA, et al. Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants. N Engl J Med 2004; 351(16): 1635-44.
[http://dx.doi.org/10.1056/NEJMoa041065] [PMID: 15483282]
[25]
Desborough M, Sandu R, Brunskill SJ, et al. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev 2015; 2015(7) ,CD007614.
[PMID: 26171897]
[26]
Bianchi P, Cotza M, Beccaris C, et al. Early or late fresh frozen plasma administration in newborns and small infants undergoing cardiac surgery: The APPEAR randomized trial. Br J Anaesth 2017; 118(5): 788-96.
[http://dx.doi.org/10.1093/bja/aex069] [PMID: 28510741]
[27]
Faraoni D, Meier J, New HV, Van der Linden PJ, Hunt BJ. Patient blood management for neonates and children undergoing cardiac sur-gery: 2019 NATA guidelines. J Cardiothorac Vasc Anesth 2019; 33(12): 3249-63.
[http://dx.doi.org/10.1053/j.jvca.2019.03.036] [PMID: 31076306]
[28]
McMichael ABV, Zimmerman KO, Kumar KR, Ozment CP. Evaluation of effect of scheduled fresh frozen plasma on ECMO circuit life: A randomized pilot trial. Transfusion 2021; 61(1): 42-51.
[http://dx.doi.org/10.1111/trf.16164] [PMID: 33269487]
[29]
Ozek E, Soll R, Schimmel MS. Partial exchange transfusion to prevent neurodevelopmental disability in infants with polycythemia. Cochrane Database Syst Rev 2010; (1): ,CD005089.
[PMID: 20091569]
[30]
Deorari AK, Paul VK, Shreshta L, Singh M. Symptomatic neonatal polycythemia: Comparison of partial exchange transfusion with saline versus plasma. Indian Pediatr 1995; 32(11): 1167-71.
[PMID: 8772864]
[31]
Roithmaier A, Arlettaz R, Bauer K, et al. Randomized controlled trial of Ringer solution versus serum for partial exchange transfusion in neonatal polycythaemia. Eur J Pediatr 1995; 154(1): 53-6.
[http://dx.doi.org/10.1007/BF01972973] [PMID: 7895756]
[32]
Krishnan L, Rahim A. Neonatal polycythemia. Indian J Pediatr 1997; 64(4): 541-6.
[http://dx.doi.org/10.1007/BF02737765] [PMID: 10771885]
[33]
Dempsey E, Barrington K. Crystalloid or colloid for partial exchange transfusion in neonatal polycythemia: A systematic review and meta-analysis. Acta Paediatr 2005; 94(11): 1650-5.
[http://dx.doi.org/10.1080/08035250500192748] [PMID: 16303705]
[34]
de Waal KA, Baerts W, Offringa M. Systematic review of the optimal fluid for dilutional exchange transfusion in neonatal polycythaemia. Arch Dis Child Fetal Neonatal Ed 2005; 91(1): F7-F10.
[http://dx.doi.org/10.1136/adc.2004.063925] [PMID: 16371393]
[35]
Hassenpflug W, Budde U, Schneppenheim S, Schneppenheim R. Inherited thrombotic thrombocytopenic purpura in children. Semin Thromb Hemost 2014; 40(4): 487-92.
[http://dx.doi.org/10.1055/s-0034-1376152] [PMID: 24816970]
[36]
Johnson CA, Snyder MS, Weaver RL. Effects of fresh frozen plasma infusions on coagulation screening tests in neonates. Arch Dis Child 1982; 57(12): 950-2.
[http://dx.doi.org/10.1136/adc.57.12.950] [PMID: 7181527]
[37]
Catford K, Muthukumar P, Reddy C, et al. Routine neonatal coagulation testing increases use of fresh-frozen plasma. Transfusion 2014; 54(5): 1444-5.
[http://dx.doi.org/10.1111/trf.12610] [PMID: 24819080]
[38]
Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the full-term infant. Blood 1987; 70(1): 165-72.
[http://dx.doi.org/10.1182/blood.V70.1.165.165] [PMID: 3593964]
[39]
Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the healthy premature infant. Blood 1988; 72(5): 1651-7.
[http://dx.doi.org/10.1182/blood.V72.5.1651.1651] [PMID: 3179444]
[40]
Christensen RD, Baer VL, Lambert DK, Henry E, Ilstrup SJ, Bennett ST. Reference intervals for common coagulation tests of preterm infants (CME). Transfusion 2014; 54(3): 627-32.
[http://dx.doi.org/10.1111/trf.12322] [PMID: 23834237]
[41]
Hellstern P, Muntean W, Schramm W, Seifried E, Solheim BG. Practical guidelines for the clinical use of plasma. Thromb Res 2002; 107 (Suppl. 1): S53-7.
[http://dx.doi.org/10.1016/S0049-3848(02)00153-6] [PMID: 12379294]
[42]
Karam O, Demaret P, Shefler A, et al. Indications and effects of plasma transfusions in critically ill children. Am J Respir Crit Care Med 2015; 191(12): 1395-402.
[http://dx.doi.org/10.1164/rccm.201503-0450OC] [PMID: 25859890]
[43]
Andrew M. The relevance of developmental hemostasis to hemorrhagic disorders of newborns. Semin Perinatol 1997; 21(1): 70-85.
[http://dx.doi.org/10.1016/S0146-0005(97)80022-5] [PMID: 9190036]
[44]
Ignjatovic V, Kenet G, Monagle P. Developmental hemostasis: Recommendations for laboratories reporting pediatric samples. J Thromb Haemost 2012; 10(2): 298-300.
[http://dx.doi.org/10.1111/j.1538-7836.2011.04584.x] [PMID: 22403808]
[45]
Venkatesh V, Khan R, Curley A, New H, Stanworth S. How we decide when a neonate needs a transfusion. Br J Haematol 2013; 160(4): 421-33.
[http://dx.doi.org/10.1111/bjh.12095] [PMID: 23094805]
[46]
Van de Bor M, Briet E, Van Bel F, Ruys JH. Hemostasis and periventricular-intraventricular hemorrhage of the newborn. Am J Dis Child 1986; 140(11): 1131-4.
[PMID: 3766488]
[47]
Tran TTH, Veldman A, Malhotra A. Does risk-based coagulation screening predict intraventricular haemorrhage in extreme premature infants? Blood Coagul Fibrinolysis 2012; 23(6): 532-6.
[http://dx.doi.org/10.1097/MBC.0b013e3283551145] [PMID: 22627584]
[48]
Bauman ME, Cheung PY, Massicotte MP. Hemostasis and platelet dysfunction in asphyxiated neonates. J Pediatr 2011; 158(2): e35-9.
[http://dx.doi.org/10.1016/j.jpeds.2010.11.011] [PMID: 21238709]
[49]
Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2004; 89(2): 152F-5.
[http://dx.doi.org/10.1136/adc.2002.023093] [PMID: 14977901]
[50]
Sarkar S, Barks JD, Bhagat I, Donn SM. Effects of therapeutic hypothermia on multiorgan dysfunction in asphyxiated newborns: Whole-body cooling versus selective head cooling. J Perinatol 2009; 29(8): 558-63.
[http://dx.doi.org/10.1038/jp.2009.37] [PMID: 19322190]
[51]
Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med 1992; 20(10): 1402-5.
[http://dx.doi.org/10.1097/00003246-199210000-00007] [PMID: 1395660]
[52]
Wolberg AS, Meng ZH, Monroe DM III, Hoffman M. A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma 2004; 56(6): 1221-8.
[http://dx.doi.org/10.1097/01.TA.0000064328.97941.FC] [PMID: 15211129]
[53]
Mitrophanov AY, Rosendaal FR, Reifman J. Computational analysis of the effects of reduced temperature on thrombin generation: The contributions of hypothermia to coagulopathy. Anesth Analg 2013; 117(3): 565-74.
[http://dx.doi.org/10.1213/ANE.0b013e31829c3b22] [PMID: 23868891]
[54]
Oncel MY, Erdeve O, Calisici E, et al. The effect of whole-body cooling on hematological and coagulation parameters in asphyxic new-borns. Pediatr Hematol Oncol 2013; 30(3): 246-52.
[http://dx.doi.org/10.3109/08880018.2013.771240] [PMID: 23445486]
[55]
Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Libr 2013; 2013(1) ,CD003311.
[http://dx.doi.org/10.1002/14651858.CD003311.pub3] [PMID: 23440789]
[56]
Forman KR, Diab Y, Wong ECC, Baumgart S, Luban NLC, Massaro AN. Coagulopathy in newborns with hypoxic ischemic encephalopa-thy (HIE) treated with therapeutic hypothermia: A retrospective case-control study. BMC Pediatr 2014; 14(1): 277.
[http://dx.doi.org/10.1186/1471-2431-14-277] [PMID: 25367591]
[57]
Williams GD, Bratton SL, Ramamoorthy C. Factors associated with blood loss and blood product transfusions: A multivariate analysis in children after open-heart surgery. Anesth Analg 1999; 89(1): 57-64.
[PMID: 10389779]
[58]
Radicioni M, Mezzetti D, Del Vecchio A, Motta M. Thromboelastography: Might work in neonatology too? J Matern Fetal Neonatal Med 2012; 25(S4): 10-3.
[http://dx.doi.org/10.3109/14767058.2012.714996] [PMID: 22958005]
[59]
Edwards RM, Naik-Mathuria BJ, Gay AN, Olutoye OO, Teruya J. Parameters of thromboelastography in healthy newborns. Am J Clin Pathol 2008; 130(1): 99-102.
[http://dx.doi.org/10.1309/LABNMY41RUD099J2] [PMID: 18550478]
[60]
Motta M, Guaragni B, Pezzotti E, Rodriguez-Perez C, Chirico G. Reference intervals of citrated-native whole blood thromboelastography in premature neonates. Early Hum Dev 2017; 115: 60-3.
[http://dx.doi.org/10.1016/j.earlhumdev.2017.09.014] [PMID: 28923772]
[61]
Ghirardello S, Raffaeli G, Scalambrino E, et al. The intra-assay reproducibility of thromboelastography in very low birth weight infants. Early Hum Dev 2018; 127: 48-52.
[http://dx.doi.org/10.1016/j.earlhumdev.2018.10.004] [PMID: 30312859]
[62]
Radicioni M, Massetti V, Bini V, Troiani S. Impact of blood sampling technique on reproducibility of viscoelastic coagulation monitor (VCM™) system test results in the neonate. J Matern Fetal Neonatal Med 2021; 25: 1-7.
[PMID: 34304670]
[63]
Radicioni M, Bruni A, Bini V, Villa A, Ferri C. Thromboelastographic profiles of the premature infants with and without intracranial hem-orrhage at birth: A pilot study. J Matern Fetal Neonatal Med 2015; 28(15): 1779-83.
[http://dx.doi.org/10.3109/14767058.2014.968773] [PMID: 25245227]
[64]
Sewell EK, Forman KR, Wong ECC, Gallagher M, Luban NLC, Massaro AN. Thromboelastography in term neonates: An alternative ap-proach to evaluating coagulopathy. Arch Dis Child Fetal Neonatal Ed 2017; 102(1): F79-84.
[http://dx.doi.org/10.1136/archdischild-2016-310545] [PMID: 27178714]
[65]
Forman KR, Wong E, Gallagher M, McCarter R, Luban NLC, Massaro AN. Effect of temperature on thromboelastography and implica-tions for clinical use in newborns undergoing therapeutic hypothermia. Pediatr Res 2014; 75(5): 663-9.
[http://dx.doi.org/10.1038/pr.2014.19] [PMID: 24522100]
[66]
Phillips RC, Shahi N, Leopold D, et al. Thromboelastography-guided management of coagulopathy in neonates with congenital diaphrag-matic hernia supported by extracorporeal membrane oxygenation. Pediatr Surg Int 2020; 36(9): 1027-33.
[http://dx.doi.org/10.1007/s00383-020-04694-0] [PMID: 32607833]
[67]
Peterson JA, Maroney SA, Zwifelhofer W, et al. Heparin-protamine balance after neonatal cardiopulmonary bypass surgery. J Thromb Haemost 2018; 16(10): 1973-83.
[http://dx.doi.org/10.1111/jth.14245] [PMID: 30016577]
[68]
Sokou R, Giallouros G, Konstantinidi A, et al. Thromboelastometry for diagnosis of neonatal sepsis-associated coagulopathy: An obser-vational study. Eur J Pediatr 2018; 177(3): 355-62.
[http://dx.doi.org/10.1007/s00431-017-3072-z] [PMID: 29255948]
[69]
Sokou R, Piovani D, Konstantinidi A, et al. A risk score for predicting the incidence of hemorrhage in critically ill neonates: development and validation study. Thromb Haemost 2021; 121(2): 131-9.
[http://dx.doi.org/10.1055/s-0040-1715832] [PMID: 32838471]
[70]
Venkatesh V, Curley A, Khan R, et al. A novel approach to standardised recording of bleeding in a high risk neonatal population. Arch Dis Child Fetal Neonatal Ed 2013; 98(3): F260-3.
[http://dx.doi.org/10.1136/archdischild-2012-302443] [PMID: 23144007]

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