Platelets are cells which help blood clot but they also have other effects such as directing pathways of inflammation. Premature babies often have low platelets, particularly if they have an infection or bowel inflammation. Doctors give platelet transfusions because they think that this prevents bleeding but there is no evidence for this. Overall, three quarters of premature babies with very low platelets in the intensive care will be given a platelet transfusion. A recent trial in 660 premature babies (PlaNeT-2) showed that if we wait until babies’ platelets drop lower (25x 109/L), before transfusing, that these babies are less likely to die or have a major bleed. Platelets appear to be causing babies harm and we don’t yet understand why.
Many doctors worldwide are now giving platelets at the level (<25 x109/L) which was shown to cause less harm in the PlaNeT -2 study. We would now like to assess the volume of platelet transfusion that we use. We give babies a volume of platelets for transfusion that is high (15ml/Kg body weight) compared to average adult volume (2-6mL/Kg) without evidence to decide if this is right or not. Our research question is: could a smaller volume for platelet transfusion help prevent bleeding but have less side effects for the baby? It is possible that giving babies too many platelets collected from adult blood donors, causes inflammation and lung disease. We will study this by looking at death /major bleeding and by measuring blood markers for inflammation before and after platelet transfusion.
Another important outcome for babies is their development at age two years. We plan to do a SWAT of an app (Little feet) designed to maintain communication with parents and help maximise our follow up data and develop a greater awareness of what parents’ value in neonatal research.
