ASPPH Friday

Transfusions with Higher Red Blood Cell Levels Do Not Improve Preterm Baby Outcomes

dhawkin — Wed, 30 Dec 2020 22:18:02 +0000

Transfusions with Higher Red Blood Cell Levels Do Not Improve Preterm Baby Outcomes dhawkin Wed, 12/30/2020 - 17:18

Largest study to-date compares thresholds for blood transfusions in premature babies

Very low birthweight infants are at a high risk for anemia and often need blood transfusions to survive. Some doctors use a higher level and some use a lower level of red blood cells to order a transfusion. A National Institutes of Health-funded study suggests that providing a higher threshold of red cells within clinically accepted limits (i.e., using a higher level of red blood cells when ordering a transfusion) offers no advantage in survival or reduction in neurological impairment over a lower threshold.

This large, multi-center randomized clinical trial was conducted by Dr. Haresh Kirpalani of the University of Pennsylvania, Dr. Edward Bell of the University of Iowa, and colleagues of the Neonatal Research Network including Dr. Rosemary Higgins of ��ӽ紫ý’s College of Health and Human Services, formerly the Project Scientist of the Neonatal Research Network. The study appears in The New England Journal of Medicine and is the largest study to-date to compare thresholds for blood transfusions in premature babies. View a brief video of the findings here.

Very preterm infants (born before 29 weeks of pregnancy) and those weighing less than 1,000 grams (slightly more than 2 pounds) are at high risk for anemia because of their early stage of development, reduced ability to produce red blood cells, and need for blood sampling as part of their intensive medical care. Previous studies suggest that anemic infants who received transfusions at a higher hemoglobin threshold within the currently accepted range would have a lower risk of death or developmental problems. Measuring hemoglobin, a protein produced in red blood cells, indicates the proportion of red blood cells. Hemoglobin transfusion thresholds for preterm infants vary according to weight, stage of maturity and other factors.

Of 845 infants assigned to a higher hemoglobin threshold, 50.1% died or survived with a neurodevelopmental impairment, compared to 49.8% of 847 infants assigned to a lower threshold. When the two component outcomes were evaluated separately, the two groups also had similar rates of death (16.2% vs. 15%) and of neurodevelopmental impairment (39.6% vs 40.3%). The authors evaluated the babies at two years of age and conclude that a higher hemoglobin threshold increased the number of transfusions, but did not improve the chance of survival without neurodevelopmental impairment.

“The findings are likely to be used to guide transfusion practice in the future for these infants; studies in premature infants are needed to guide care for these small and vulnerable infants; studies funded by NIH in multi-site networks are vitally important to the health of these fragile babies,” explains Higgins.

The babies in this study are currently being seen at five years of age for continued assessment to check for long-term differences in the higher and lower threshold groups.

This study was supported by grants from the National Heart, Lung, and Blood Institute to Drs. Kirpalani, Bell and Das; and by the NICHD to the Neonatal Research Network site investigators. The National Institutes of Health (NIH), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Heart, Lung, and Blood Institute (NHLBI), the National Center for Research Resources (NCRR), and the National Center for Advancing Translational Sciences (NCATS) provided grant support for the Neonatal Research Network’s Transfusion of Preemies (TOP) trial through cooperative agreements.

About ��ӽ紫ý

��ӽ紫ý is Virginia's largest and most diverse public research university. Located near Washington, D.C., Mason enrolls 39,000 students from 130 countries and all 50 states. Mason has grown rapidly over the past half-century and is recognized for its innovation and entrepreneurship, remarkable diversity and commitment to accessibility. For more information, visit https://www2.gmu.edu/.

About the College of Health and Human Services

��ӽ紫ý's College of Health and Human Services prepares students to become leaders and shape the public's health through academic excellence, research of consequence, community outreach, and interprofessional clinical practice. ��ӽ紫ý is the fastest-growing Research I institution in the country. The College enrolls more than 1,900 undergraduate and 1,370 graduate students in its nationally-recognized offerings, including: 5 undergraduate degrees, 13 graduate degrees, and 7 certificate programs. The college is transitioning to a college public health in the near future. For more information, visit https://chhs.gmu.edu/.

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College of Health and Human Services

Kathryn Hogan Studies Malaria Knowledge, Attitudes, and Practices of the Peruvian Maijuna Community for Master’s Thesis

dhawkin — Thu, 23 Jul 2020 13:42:15 +0000

Kathryn Hogan Studies Malaria Knowledge, Attitudes, and Practices of the Peruvian Maijuna Community for Master’s Thesis dhawkin Thu, 07/23/2020 - 09:42

Recent graduate completes first international MS in Global Health thesis studying the knowledge, attitudes, and practices related to malaria of an indigenous group in the Peruvian Amazon.

“I’m really interested in looking at Global Health through a One Health lens, which is increasingly important during this time of COVID-19, as we expect more diseases such as this to spillover from animals to humans in the future,” explained Hogan. “One Health is a transdisciplinary approach to health which recognizes the interconnectedness between human, animal, and environmental health.”

For her master's thesis, Kathryn Hogan traveled to Peru to explore how the Maijuna experience and perceive malaria, and how those experiences and perceptions shape preventative and treatment-seeking behavior.

Hogan chose to pursue her master’s degree at Mason because of the faculty focus on using a One Health approach to study zoonotic diseases, the University’s location in the Washington, D.C. area, and the endless opportunities the area provides for public and global health.

“When researching programs for my master’s, I was interested in Mason’s opportunities and I saw that Dr. Michael von Fricken focused on this One Health perspective,” she added. “That drove me to apply to Global Health programs and their Graduate Research Assistantships at Mason.”

The MS in Global Health at Mason requires that students complete a thesis on a topic of their choice as a culminating experience for the degree, and Hogan chose to complete her thesis in Peru, becoming the first student in the department to complete a thesis abroad. She expects more students will take this opportunity to do international research for their projects in the future.

She was inspired by an international field course she took earlier in her Mason program, Conservation and Sustainability in the Amazon with Dr. Michael Gilmore and Dr. Andrew Wingfield, run through the Center for Field Studies. The course was co-taught by members of the indigenous Maijuna people of the community of Sucusari, Peru. The course focused on conservation of biological and cultural diversity and environmental justice, but malaria transmission came up in conversation with community members. Malaria is still prevalent in many parts of South America, mainly within regions of the Amazon rainforest in Peru and Brazil.

“This sparked a conversation with Dr. Gilmore and I about the history of malaria in the community, why there appeared to be confusion in the community about malaria transmission, and if the community was receiving health programming and resources from the Peruvian government,” elaborated Hogan.

After constructing the framework of the study, Hogan received funding to conduct research in Peru through Mason’s Global Praxis program.

Hogan’s study was designed to explore how the Maijuna experience and perceive malaria, and how those experiences and perceptions shape preventative and treatment-seeking behavior. She found that perceptions of malaria were rooted in a mixture of tradition, personal experiences, and past teachings from local government programs. Confusion surrounding transmission could likely be avoided through culturally-appropriate health workshops.

During her qualitative, interview-based research, Hogan stayed in one of the Maijuna communities called Sucusari, in Loreto, Peru. She stayed in a traditional house built for field studies by a local NGO, OnePlanet, with other bilingual researchers which helped her as she adjusted to new cultural norms and language.

During her qualitative, interview-based research, Hogan stayed in one of the Maijuna communities called Sucusari, in Loreto, Peru.

“The Sucusari community members were very welcoming and gracious to allow me to stay in their community for three months and learn about their experiences, knowledge, attitudes, and practices surrounding malaria,” described Hogan.

In reflection, Hogan thinks the most rewarding part of the experience was the interest and support the community expressed during the very first meeting in Sucusari.

“When Dr. Gilmore and I introduced the research project to see if there was interest among community leadership, and then later among the whole community, there was a lot of support and interest in the project. The community members shared their experiences being sick or having family members who were sick or died from malaria in the past, so they were really interested in sharing that information. Because indigenous populations have historically been marginalized and exploited for research or economic gain, doing ethical work that was of interest and benefit to the community was of utmost importance,” Hogan emphasized.

After completing her thesis and graduating from Mason in spring of 2020, Hogan began a full-time role as a Health Analyst at MITRE. In the future, she plans to pursue a doctoral degree.

New Screening Tool Can Tell the Difference Between COVID-19 and the Flu, and It’s Evidence-Based and Free

dhawkin — Thu, 02 Jul 2020 20:51:31 +0000

New Screening Tool Can Tell the Difference Between COVID-19 and the Flu, and It’s Evidence-Based and Free dhawkin Thu, 07/02/2020 - 16:51