Un nuevo estudio publicado en Journal of Perinatology, está ayudando a evitar las transfusiones de sangre en bebés prematuros gracias a una nueva investigación y colaboración entre investigadores de Intermountain Health y University of Utah.

Timothy Bahr, MD, neonatólogo e investigador clínico de Intermountain Health, colaboró con Robert Christensen, MD, y Robin Ohls, MD, de University of Utah Health, a explorar la dosis y frecuencia necesarias de una medicación llamada darbepoetina (darbe), la cual estimula la producción de glóbulos rojos en bebés prematuros.

Los bebés prematuros a menudo sufren de niveles de glóbulos rojos bajos (anemia), lo cual puede contribuir a varias complicaciones tales como el retraso en el desarrollo y la dificultad para respirar.

Se han utilizado inyecciones subcutáneas de darbe para tratar, de manera eficaz, la anemia causada por nacimiento prematuro y estimular la producción de glóbulos rojos en bebés prematuros, para así reducir la necesidad de transfusiones de glóbulos rojos en Estados Unidos en los últimos 20 años.

El objetivo del estudio fue refinar la dosis y frecuencia de darbe en estos bebés vulnerables, para brindar beneficios de salud óptimos, junto con el número menor de inyecciones subcutáneas necesarias.

El Dr. Bahr y sus colaboradores, quienes han estado al frente de la investigación en el tratamiento de anemia en bebés prematuros, condujeron su estudio en Intermountain Medical Center en Murray y en Intermountain Valley Hospital en Provo.

El estudio analizó dos horarios de dosis diferentes: inyecciones una vez a la semana, y una cada dos semanas.

Los resultados fueron prometedores.

“Encontramos que, mientras las dosis semanales de darbe incrementaban la producción de glóbulos rojos levemente, ambos horarios resultaron similares en cuanto a beneficios para la salud en los bebés”, dijo el Dr. Bahr. “Esto significa que administrar Darbe cada dos semanas sería una opción viable, reduciendo así el número de inyecciones que estos bebés necesiten”.

“Administrar menos inyecciones puede resultar en una experiencia más llevadera para los bebés prematuros y sus padres, y también podría, potencialmente, disminuir los gastos farmacéuticos y de atención médica”, añadió.

De acuerdo con neonatólogos, cuando darbe aumenta los niveles de glóbulos rojos a niveles más normales en bebés prematuros, estos tienen una menor probabilidad de necesitar transfusiones de sangre.

Algunos bebés prematuros solo necesitan inyecciones de darbe, mientras que otros pacientes recién nacidos en estado más crítico también pueden llegar a necesitar una transfusión de sangre para ayudarles a mejorar sus probabilidades de supervivencia en la unidad de la UCI neonatal.

“Las transfusiones de sangre se pueden realizar de manera segura y pueden salvar la vida de bebés prematuros, pero conllevan ciertos riesgos. Si podemos reducir la necesidad de transfusiones de sangre en bebés prematuros, también podemos reducir el riesgo de complicaciones que pueden suceder después de una transfusión de sangre”, dijo el Dr. Bahr.

Según el Dr. Bahr, la tasa de transfusiones de sangre en bebés prematuros en las unidades UCI neonatales de Intermountain Health está bastante por debajo del promedio nacional.

Durante los últimos 20 años, Intermountain ha utilizado darbe y ha continuado su investigación para hallar las mejores prácticas para esta medicación, lo cual es parte del esfuerzo en reducir el número de transfusiones necesarias en bebés prematuros.

“La eliminación de transfusiones de sangre innecesarias en Intermountain Health o la ‘responsabilidad con las transfusiones’, es muy parecida a nuestros esfuerzos en cuanto a la responsabilidad con los antibióticos, la cual promueve el uso responsable de antibióticos y reduce el uso innecesario y mejora la atención del paciente y los resultados”, dijo el Dr. Bahr.

“Los resultados de este estudio de investigación ofrecen un enfoque potencialmente nuevo en la administración de darbepoetina a bebés prematuros, proporcionando un equilibrio entre el tratamiento efectivo y el beneficio de realizar menos intervenciones médicas”, dijo Elizabeth O’Brien, MD, directora médica principal de la salud neonatal en Intermountain Health. “Esta es una de las muchas maneras en las que Intermountain está trabajando para mejorar la salud y el bienestar de los bebés prematuros y brinda una atención más avanzada y compasiva para estos pacientes tan pequeños y vulnerables”.

Intermountain Primary Children´s Hospital tiene la UCI neonatal de nivel IV más destacada en la zona Mountain West, e Intermountain tiene otros 17 hospitales adicionales (10 en Utah) con unidades UCI neonatales.

Los profesionales de la salud de los 20 hospitales de Intermountain Health que tienen unidades de parto en Utah, tienen acceso a interconsultas con neonatólogos virtuales las 24 horas del día, siete días a la semana. Intermountain Health está nacionalmente reconocido por la habilidad única de ofrecer telemedicina neonatal de alto nivel a hospitales rurales.

###

A new study published in the Journal of Perinatology is helping premature babies avoid blood transfusions, thanks to new research and collaboration between researchers at Intermountain Health and the University of Utah.

Timothy Bahr, MD, an Intermountain Health neonatologist and researcher, collaborated with Robert Christensen, MD, and Robin Ohls, MD, from University of Utah Health, to explore the dosage and frequency needed of a medication called darbepoetin (darbe), which boosts red blood cell production in premature infants.

Premature babies often suffer from low red blood cell counts (anemia), which can contribute to various complications such as developmental delays and difficulty breathing.

Subcutaneous injections of darbe have been used to effectively treat anemia of prematurity and boost red blood cell production in premature infants, to help decrease the need for red blood cell transfusions in the United States for the past 20 years.

The goal of the study was to refine the dosage and frequency of darbe to these vulnerable babies, so it provides optimal health benefits, along with the minimum necessary number of subcutaneous injections.

Dr. Bahr and his collaborators, who have been at the forefront of research on treatment for anemia in premature babies, conducted their study at Intermountain Medical Center in Murray and Intermountain Utah Valley Hospital in Provo.

The study tested two different dosing schedules: injections once a week and once every two weeks.

The results were promising.

"We found that while weekly doses of darbe increased red blood cell production slightly more, both schedules resulted in similar overall health outcomes for the babies," said Dr. Bahr. "This means that giving Darbe every two weeks could be a viable option, reducing the number of injections these infants need.”

“Fewer injections can lead to a more comfortable experience for premature babies and their parents, and it also could potentially lower healthcare and pharmacy costs,” he added. 

According to neonatologists, when darbe improves red blood cell counts to more normal levels in premature infants, they are less likely to need a blood transfusion.

Some preemies need only darbe injections, while more severe newborn patients may also need a blood transfusion to help them be more likely to survive their stay in a neonatal ICU.

“Transfusions can be done safely and can be lifesaving for preemies, but they do come with some risks. If we can reduce the need for blood transfusions in preemies, we can also reduce their risk of complications which can occur after a blood transfusion,” said Dr Bahr.

According to Dr. Bahr, the transfusion rate of premature infants in Intermountain Health neonatal ICUs is well below the national average.

Intermountain’s use of darbe and its ongoing research into best practices for the medication over the last 20 years are all part of an effort to reduce the number of transfusions preterm babies require.

“Eliminating unnecessary blood transfusions at Intermountain Health or ‘transfusion stewardship’ is much like our antibiotic stewardship efforts, which promote responsible use of antibiotics and reduces unnecessary use and enhances patient care and outcomes,” said Dr. Bahr.

“This research study’s findings offer a potential new approach to administering darbepoetin to premature babies, providing a balance between effective treatment and the comfort of fewer medical interventions,” said Elizabeth O’Brien, MD, senior medical director for neonatal health at Intermountain Health. “This is one of the many ways Intermountain is working to enhance the health and well-being of premature infants and provide more advanced and compassionate care for these very young and vulnerable patients.”

Intermountain Primary Children’s Hospital is home to the leading Level IV Neonatal ICU in the Mountain West, and Intermountain has 17 other hospitals (10 in Utah) with a neonatal ICU. 

Providers at all 20 Intermountain Health hospitals with labor and delivery units in Utah have access to virtual neonatologists 24 hours a day, seven days a week. Intermountain Health is nationally recognized for the unique ability to provide this high-level of neonatal telemedicine to rural hospitals.

###

When it comes to a stroke, every second counts. For patients with ischemic strokes, getting medication as quickly as possible to break up clots and restore blood flow to the brain is critical because every passing minute means more brain cells are deprived of oxygen and possibly lost. 

While the evidence-based practice is often clearly understood – the coordination required to improve timely delivery of clot-busting medication presents unique implementation challenges for healthcare delivery systems.

Now, a new study from neurology researchers and implementation scientists at Intermountain Health demonstrates that when a systemwide stroke protocol is implemented with a degree of local tailoring across a health system, treatment time for stoke patients at all impacted hospitals significantly improves giving patients a better chance at survival and recovery.

For the study, neurology leaders at Intermountain worked to empower each of the Intermountain hospitals – rural and urban, large and small – to customize the implementation of protocols to fit that hospital’s unique environment and patient population.

Nearly all participating hospitals saw a dramatic drop in the gap between when a patient calls for help, and when clot-busting medication, tPA, is administered. Several hospitals improved by more than 20 minutes – which translates into a lot of brain cells saved.

Findings from the new study examining the systemwide implementation are published this month in the journal, Circulation: Cardiovascular Quality and Outcomes.

“We want to provide the same high quality stroke care throughout our entire healthcare system, whether you come into our flagship urban hospital, or a small rural hospital that might only see patients who need tPA medication once or twice a year,” said Kathleen McKee, MD, co-lead author of the study and associate medical director of neurosciences research at Intermountain Healthcare. “This research shows we’re getting closer to that reality.”

“The delivery of acute stroke care is complex within an emergency department. This can present challenges for clinicians seeking to deliver high quality care for each patient. In this study, we found that defining centrally ‘what’ needed to happen across all emergency departments, while providing each site with flexibility or tailoring to their local circumstances led to better care across all sites,” said Andrew Knighton, PhD, an implementation scientist and co-lead author on the study. 

The study involved 21 Intermountain Health emergency departments in Utah and Idaho, with four being dedicated stroke centers. For the study, each hospital site received acute stroke care implementation strategies to get tPA medication to appropriate patients as soon as possible, as previous research has shown that tPA given within six hours of a stroke significantly increases the chance of someone surviving a stroke and reduces chances of disability.

Each hospital worked with a central Intermountain Health team to brainstorm what implementation strategies would work best for deployment of the protocol within their emergency department. This led to each emergency department coming up with unique implementation solutions specifically tailored to their and their patients’ needs for timely tPA delivery.

In the study, researchers tracked the effectiveness of the acute stroke care program’s implementation from January 2018 to February 2020. During that time, those hospital emergency departments had 855,474 patient encounters, with 5,325 code stroke activations. Of those, 615 patients received tPA in less than three hours of symptom onset.

The research team measured door-to-needle (DTN) times—or the time from when a patient arrives in the emergency department to the time the intravenous needle delivers tPA.  

The study demonstrated that the percentage of DTN times under 60 minutes increased from 72.5% to 86.1%. Researchers also found the biggest improvement in rural and frontier non-stroke center emergency departments.

“This suggests further contextual differences may exist between non-stroke center emergency departments that need to be better understood, driven perhaps by differences in patient volumes, site leadership and decision-making, team dynamics, and resources,” said Knighton.

Overall, the Intermountain researchers say the study demonstrates that a centrally led but locally customized approach can be utilized to improve acute stroke care across very diverse emergency departments.

###