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

@article{houben2026blood,
  title = {{Blood loss due to diagnostic testing in extremely preterm infants in 22 European countries: a prospective observational study}},
  author = {Nina Houben and Suzanne Fustolo-Gunnink and Karin Fijnvandraat and Camila Caram-Deelder and Marta Aguar Carrascosa and Alain Beuchée and Kristin Brække and Francesco Cardona and Anne Debeer and Sara Domingues and Stefano Ghirardello and Ruza Grizelj and Emina Hadžimuratović and Christian Heiring and Jana Lozar Krivec and Jan Malý and Katarina Matasova and Carmel Maria Moore and Tobias Muehlbacher and Miklos Szabó and Tomasz Szczapa and Gabriela Zaharie and Justine de Jager and Nora Johanna Reibel-Georgi and Helen New and Simon Stanworth and Emöke Deschmann and Charles Roehr and Christof Dame and Saskia Le Cessie and Johanna van der Bom and Enrico Lopriore and Nina A.M. Houben and Miguel Alsina-Casanova and Ola Andersson and Rosa Patricia Arias-Llorente and Adeline Berenger and Edyta Bielska and Marioara Boia and André Birkenmaier and Jakub Biros and Anne Laure Blanquart and Tiziana Boggini and Pascal Boileau and Renata Bokiniec and Ilia Bresesti and Katherine Broad and Giacomo Cavallaro and Jennifer Chauvel and Borbála Cseszneki and Carlo Dani and Klaudia Demová and Diana Dornis and Marie-Pierre Duban and Karolina Dziadkowiec-Motyl and Nika Erzen and Eszter Fanczal and Sara Fernández-Castiñeira and Libusa Galuschka and Ellen Gandaputra},
  journal = {EClinicalMedicine},
  year = {2026},
  month = oct,
  doi = {10.1016/j.eclinm.2026.104035},
  url = {https://univ-rennes.hal.science/hal-05825582v1},
  note = {CC BY},
}

TY  - JOUR
TI  - Blood loss due to diagnostic testing in extremely preterm infants in 22 European countries: a prospective observational study
AU  - Nina Houben
AU  - Suzanne Fustolo-Gunnink
AU  - Karin Fijnvandraat
AU  - Camila Caram-Deelder
AU  - Marta Aguar Carrascosa
AU  - Alain Beuchée
AU  - Kristin Brække
AU  - Francesco Cardona
AU  - Anne Debeer
AU  - Sara Domingues
AU  - Stefano Ghirardello
AU  - Ruza Grizelj
AU  - Emina Hadžimuratović
AU  - Christian Heiring
AU  - Jana Lozar Krivec
AU  - Jan Malý
AU  - Katarina Matasova
AU  - Carmel Maria Moore
AU  - Tobias Muehlbacher
AU  - Miklos Szabó
AU  - Tomasz Szczapa
AU  - Gabriela Zaharie
AU  - Justine de Jager
AU  - Nora Johanna Reibel-Georgi
AU  - Helen New
AU  - Simon Stanworth
AU  - Emöke Deschmann
AU  - Charles Roehr
AU  - Christof Dame
AU  - Saskia Le Cessie
AU  - Johanna van der Bom
AU  - Enrico Lopriore
AU  - Nina A.M. Houben
AU  - Miguel Alsina-Casanova
AU  - Ola Andersson
AU  - Rosa Patricia Arias-Llorente
AU  - Adeline Berenger
AU  - Edyta Bielska
AU  - Marioara Boia
AU  - André Birkenmaier
AU  - Jakub Biros
AU  - Anne Laure Blanquart
AU  - Tiziana Boggini
AU  - Pascal Boileau
AU  - Renata Bokiniec
AU  - Ilia Bresesti
AU  - Katherine Broad
AU  - Giacomo Cavallaro
AU  - Jennifer Chauvel
AU  - Borbála Cseszneki
AU  - Carlo Dani
AU  - Klaudia Demová
AU  - Diana Dornis
AU  - Marie-Pierre Duban
AU  - Karolina Dziadkowiec-Motyl
AU  - Nika Erzen
AU  - Eszter Fanczal
AU  - Sara Fernández-Castiñeira
AU  - Libusa Galuschka
AU  - Ellen Gandaputra
PY  - 2026
DA  - 2026/10/20
JO  - EClinicalMedicine
DO  - 10.1016/j.eclinm.2026.104035
UR  - https://univ-rennes.hal.science/hal-05825582v1
AB  - 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.
SN  - 2589-5370
ER  -