Blood loss due to diagnostic testing in extremely preterm infants in 22 European countries: a prospective observational study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Extremely preterm infants often develop anemia of prematurity, partly caused by blood losses for laboratory diagnostic tests during their stay in the neonatal intensive care unit (NICU). However, international quantitative data on diagnostic blood loss in extremely preterm infants are limited. Methods: We performed an international, prospective, observational study across 64 NICUs across 22 European countries (ISRCTN17267090) to describe diagnostic blood losses during the first 28 days after birth in extremely preterm infants born below 28 weeks. Data collected between September 1st, 2022 and August 31st, 2023 (6-weeks per center). Findings: We included 320 extremely preterm infants (46% female; median gestational age at birth 26 + 1 weeks; median birthweight 800 g). Median estimated cumulative diagnostic blood loss at day 28 in infants born at 24, 25, 26, 27 weeks' gestation was 49.6%, 25.9%, 19.7%, 11.5% of calculated initial blood volume (assuming 70 mL/kg birthweight), respectively. Median number of laboratory tests ranged from 6.5 to 25 per center after birth (postnatal day 1-2), and median associated diagnostic blood loss on day 1 and 2 combined ranged from 1.6 to 26.7 mL/kg. There was considerable variation between centers in minimum blood volumes required for laboratory testing. Infants admitted to centers with small-volume analyzers experienced half the cumulative diagnostic blood loss by day 28 (8.2 mL/kg), compared to those admitted to centers with medium- and large-volume analyzers (17.3 and 19.9 mL/kg, respectively). Interpretation: In this cohort study of extremely preterm infants, we found significant diagnostic blood losses, particularly in the first week, resulting in an estimated cumulative loss of half of the initial blood volume in infants born at 24 weeks. Our findings highlight considerable variations between European centers, underlining the need to understand these differences and minimize diagnostic blood losses whenever possible in this vulnerable patient population. Funding: Sanquin, ESPR, EBA.
Source: EClinicalMedicine
Authors: Nina A.M. Houben, Suzanne Fustolo-Gunnink, Karin Fijnvandraat, Camila Caram-Deelder, Marta Aguar Carrascosa, Alain Beuchée, Kristin Brække, Francesco Cardona, Anne Debeer, Sara Domingues, Stefano Ghirardello, Ruza Grizelj, Emina Hadžimuratović, Christian Heiring, Jana Lozar Krivec, Jan Malý, Katarina Matasova, Carmel Maria Moore, Tobias Muehlbacher, Miklos Szabó, Tomasz Szczapa, Gabriela Zaharie, Justine de Jager, Nora Johanna Reibel-Georgi, Helen V. New, Simon J. Stanworth, Emöke Deschmann, Charles C. Roehr, Christof Dame, Saskia le Cessie, Johanna van der Bom, Enrico Lopriore, Miguel Alsina-Casanova, Ola Andersson, Rosa Patricia Arias-Llorente, Adeline Berenger, Edyta Bielska, Marioara Boia, André Birkenmaier, Jakub Biros, Anne Laure Blanquart, Tiziana Boggini, Pascal Boileau, Renata Bokiniec, Ilia Bresesti, Katherine Broad, Giacomo Cavallaro, Jennifer Chauvel, Borbála Cseszneki, Carlo Dani, Klaudia Demová, Diana Dornis, Marie-Pierre Duban, Karolina Dziadkowiec-Motyl, Nika Erzen, Eszter Fanczal, Sara Fernández-Castiñeira, Libusa Galuschka, Ellen Gandaputra, Fermín García-Muñoz Rodrigo, Corinna Gebauer, Hélène Grimault, Kristina Grund, Melanie Gsöllpointner, Silvia Gualdi, Brunetta Guaragni, Markus Hahn, Nadja Haiden, Monica Hasmasanu, Daniela Iacob, Mihaela Ivanici, Raphaela Jernej, Tomáš Juren, Karolina Karcz, Lilijana Kornhauser, Barbara Królak-Olejnik, Lena Legnevall, Verena Lehnerer, Emmanuelle Levine, David Ley, María Del Carmen López Castillo, Mariella Magarotto, Silvia Martini, Iwona Maruniak-Chudek, Rita Moita, Anjola Mosuro, Agnieszka Nowicka, Daniel O'Reilly, Manuela Pantea, Alejandro Pérez-Muñuzuri, Tina Perme, Laura Picciau, Simone Pratesi, Sandra Prins, Maurizio Radicioni, Genny Raffaeli, Reyes Roldan-López, Jean-Michel Roué, Beata Rzepecka Węglarz, Greta Sibrecht, Pauline Snijder, Mirta Starčević, Emese Szántó, Liliana Teixeira, Laura Torrejon, Lourdes Urquía Martí, Laurien Vanbuggenhout, Lorenzo Zanetto
Institutions: Leiden University Medical Center, Sanquin, Emma Kinderziekenhuis, Amsterdam University Medical Centers, University of Amsterdam, Hospital Universitari i Politècnic La Fe, Centre Hospitalier Universitaire de Rennes, Oslo University Hospital, Medical University of Vienna, Universitair Ziekenhuis Leuven, Unidade Local de Saúde de Santo António EPE, Policlinico San Matteo Fondazione, University Hospital Centre Zagreb, University of Zagreb, Copenhagen University Hospital, Rigshospitalet, University of Ljubljana, Ljubljana University Medical Centre, University Hospital Hradec Králové, Martin University Hospital, University College Dublin, National Maternity Hospital, University Hospital Zurich, Semmelweis University, Poznan University of Medical Sciences, Iuliu Hațieganu University of Medicine and Pharmacy, Charité - Universitätsmedizin Berlin, University of Oxford, Karolinska Institutet, North Bristol NHS Trust, Southmead Hospital, University of Bristol
Language: English
Subfield: Biochemistry
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,780
Funders: Department of Pediatrics, School of Medicine, Emory University, Yale University, George Washington University, Children's National Hospital, University of Adelaide, European Society for Paediatric Research, Stichting Sanquin Bloedvoorziening, Weill Cornell Medical College, School of Medicine and Health Sciences, George Washington University, Weill Cornell Medicine, European Maritime and Fisheries Fund
Awards: G1626872890, G1642007678
OpenAlex ID: W7166012638