Abstract
Background and aims: The Objective was to develop and pilot a bleeding assessment tool (BAT) for use in a neonatal setting, to standardise recording of bleeding in a high risk population.
Methods: Measurement theory was used to develop the BAT in three steps: identify patient population; item generation and reduction; item review and tool formatting. Items were generated by: literature review; review of existing bleeding scales; expert opinion. The BAT was reviewed and modified by local neonatal/haematology focus groups. The tool was used to assess daily bleeding prospectively in all neonates requiring high dependency or intensive care in a single tertiary NICU over a 4 week period. A number of assessments were repeated by a second independent assessor. Inter-rate reliability was calculated as percentage of matching records.
Results: 23 neonates were assessed with total of 241 daily records. Median birth weight was 1400 (IQR 900-2400)g. Median gestational age at birth was 30 (IQR 27-36) weeks. Incidence of bleeding (represented as bleeding days/study days) was: major 14/227 (6%); moderate 130/227 (57%); minor 26/227 (11%). The median lowest platelet count was 164 (IQR 80-264). 53/63 (84%) daily duplicate assessments performed correlated. The most frequent form of minor bleeding was microscopic haematuria (6%).
Conclusions: The BAT may provide a useful method for the systematic recording of bleeding in neonates, and be of value in clinical trials. Rates of major bleeding are low but 74% of infants show evidence of bleeding, although the clinical significance of many types of bleeds remains unclear.
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Venkatesh, V., Muthukumar, P., Smethhurst, H. et al. 840 The Prevalence and Pattern of Neonatal Bleeding: Validation of a Novel Bleeding Assessment Tool (BAT). Pediatr Res 68 (Suppl 1), 421 (2010). https://doi.org/10.1203/00006450-201011001-00840
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DOI: https://doi.org/10.1203/00006450-201011001-00840