Blood loss due to diagnostic testing in extremely preterm infants in 22 European countries: a prospective observational study

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.

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Journal
EClinicalMedicine
Published
2026-06-26
DOI
https://doi.org/10.1016/j.eclinm.2026.104035
Primary Topic
Blood transfusion and management
Type
article
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0.00

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article

Blood loss due to diagnostic testing in extremely preterm infants in 22 European countries: a prospective observational study

Renata Bokiniec, Fermín García‐Muñoz Rodrigo, Katarína Matasová, Francesco Cardona et al.
EClinicalMedicine
Blood transfusion and management
article

Blood loss due to diagnostic testing in extremely preterm infants in 22 European countries: a prospective observational study

Renata Bokiniec, Fermín García‐Muñoz Rodrigo, Katarína Matasová, Francesco Cardona, Rosa Patricia Arias-Llorente, Miguel Alsina Casanova, Simon Stanworth, Greta Sibrecht, Nina A. M. Houben, Kristin Brække, Christian Heiring, Nadja Haiden, Sara Fernández-Castiñeira, K. Fijnvandraat, Carlo Dani, Silvia Martini, Jana Lozar Krivec, Emmanuelle Levine, Stefano Ghirardello, Enrico Lopriore, Ola Andersson, Miklós Szabó, Christof Dame, Emina Hadžimuratović, Karolina Karcz, Justine de Jager, Manuela Pantea, Maurizio Radicioni, Tobias Muehlbacher, Anne Debeer, Emöke Deschmann, Ilia Bresesti, Camila Caram‐Deelder, Alain Beuchée, Brunetta Guaragni, Rita Moita, Iwona Maruniak‐Chudek, Tomáš Juren, Lena Legnevall, Giacomo Cavallaro, M. Aguar Carrascosa, Carmel Maria Moore, André Birkenmaier, Daniel O’Reilly, Tiziana Boggini, Jean‐Michel Roué, Genny Raffaeli, Jennifer Chauvel, Tomasz Szczapa, Edyta Bielska, Tina Perme, Eszter Fanczal, Ruža Grizelj, Melanie Gsöllpointner, Sara Domingues, Markus Hahn, Agnieszka Nowicka, David Ley, Beata Rzepecka Węglarz, Libusa Galuschka, Reyes Roldan-López, Jakub Biros, Nika Erzen, Silvia Gualdi, Raphaela Jernej, Verena Lehnerer, Borbála Cseszneki, Hélène Grimault, Karolina Dziadkowiec-Motyl, Diana Dornis, Laura Picciau, Lilijana Kornhauser, Adeline Berenger, Klaudia Demová, Anne Laure Blanquart, Anjola Mosuro, Mihaela Ivanici, M. C. Duban, María del Carmen López Castillo, Jan Malý, Kristina Grund, Barbara Królak-Olejnik, Mariella Magarotto, Corinna Gebauer, Alejandro Pérez-Muñuzuri, C C Roehr, Ellen Gandaputra, Nora Johanna Reibel-Georgi, Sandra Prins, Daniela Iacob, Helen V. New, Gabriela Zaharie, Katherine Broad, Pascal Boileau, Johanna van der Bom, Suzanne Fustolo-Gunnink, Marioara Boia, Monica Hasmasanu, Saskia le Cessie, Simone Pratesi
article en

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.

EClinicalMedicineVol. 97
University College Dublin (IE), Semmelweis University (HU), University of Sarajevo (BA), Poznan University of Medical Sciences (PL), Oslo University Hospital (NO), North Bristol NHS Trust (GB), NHS Blood and Transplant (GB), University Hospital Centre Zagreb (HR), University of Ljubljana (SI), Iuliu Hațieganu University of Medicine and Pharmacy (RO), Leiden University Medical Center (NL), Universitair Ziekenhuis Leuven (BE), Southmead Hospital (GB), Ljubljana University Medical Centre (SI), Copenhagen University Hospital (DK), Rigshospitalet (DK), Karolinska Institutet (SE), Hospital Universitari i Politècnic La Fe (ES), Sanquin (NL), University of Bristol (GB), University of Oxford (GB), Emma Kinderziekenhuis (NL), University Hospital of Zurich (CH), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), National Maternity Hospital (IE), University Hospital Hradec Králové (CZ), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Centre Hospitalier Universitaire de Rennes (FR), Martin University Hospital (SK), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE), University of Amsterdam (NL)
European Society for Paediatric Research, Stichting Sanquin Bloedvoorziening
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Blood transfusion and management
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