Northridge Hospital Medical Center,Dignity Health

Red blood cell (RBC) transfusion practices in neonatal intensive care units are variable. Determining which patients should be transfused, and the specific hemoglobin or hematocrit thresholds, remains a recurring challenge in neonatal intensive care. Although some well-conducted randomized controlled trials and short-term follow-up studies exist for premature infants, data on term infants remain limited. Most information on term infants is derived from heterogeneous observational studies or expert consensus guidelines intended for a wider pediatric critical care population. In this review, we summarize the current literature on RBC transfusions in preterm and term infants, discuss unique characteristics of critically ill infants with varying comorbidities, and provide general strategies to guide the neonatologist in deciding when to transfuse RBCs. We also review specific considerations during RBC transfusion, such as volume, rate, and preparation as well as strategies to decrease the need for RBC transfusions.

Introduction and Objective: While missed meal boluses are common in people with diabetes, glycemic control may be maintained with frequent autocorrections.1 The present study assessed MiniMed™ 780G system (MM780G) glycemic metrics and insulin delivery during real-world use on days when users did not bolus. Methods: Global CareLink™ personal data (as of October 26, 2024), of 43,952 consenting MM780G users who had ≥10 days of sensor use, were assessed for days when there were no user-initiated boluses. Time spent within 70-180 mg/dL (TIR), below 70 mg/dL (TBR) and above 180 mg/dL (TAR) range, the glucose management indicator (GMI), and insulin were analyzed based on use of recommended optimal settings (ROS, 100 mg/dL glucose target [GT] and 2 hours active insulin time [AIT]) for ≥95% of the time. Results: On days without user-initiated boluses, ROS users had a mean TIR, TAR, TBR and GMI of 76.2%, 23.0%, 0.7% and 6.9%, respectively, while non-ROS users had means of 70.6%, 28.5%, 0.7% and 7.1%, respectively (Figure). ROS users had a higher total daily insulin dose than non-users and ROS use was associated with more people achieving consensus TIR, TBR and GMI goals (Figure). Conclusion: These data demonstrate safe and effective glycemic control with the MiniMed™ 780G system on days without user-initiated boluses and a greater proportion of real-world users achieving glycemic goals when recommended optimal settings are used. J.J.F. McVean: Employee; Medtronic. Z. Dai: Employee; Metronics. F. Niu: None. J. Shin: Employee; Medtronic. R.A. Vigersky: Employee; Medtronic.

Introduction and Objective: Glycemic control in diabetes can differ from person to person and automated insulin delivery (AID) with frequent autocorrections provides more personalized diabetes management. The present study assessed glycemic outcomes and insulin use of MiniMed™ 780G system (MM780G) users with different daily carbohydrate intake. Methods: CareLink™ personal data (as of October 26, 2024) of 19,286 consenting MM780G users (18-80yrs) in the United States (US) who had ≥10 days of sensor use and used recommended optimal settings (ROS, 100 mg/dL glucose target [GT] and 2 hours active insulin time [AIT]) ≥95% of the time were analyzed. Glycemic metrics including time in 70-140 mg/dL (TITR), in 70-180 mg/dL (TIR), below 70 mg/dL and above 180 mg/dL range and insulin use were stratified by quartiles of daily announced CHO. Results: Across increased daily CHO, the total daily dose of insulin (TDD), total bolus and number of CHO entries were greater, while autocorrection insulin (as %TDD) was less (Figure). The highest quartile had the highest mean TITR (57.2%), TIR (81.6%) and insulin-to-carb ratio (8.8±4.6), while the converse was observed for the lowest quartile. Conclusion: Regardless of CHO intake, a majority of MM780G users in the US with ROS achieved consensus-recommended glycemic goals. The MM780G’s unique algorithm permits adaptation to different CHO intake of people with diabetes. R.A. Vigersky: Employee; Medtronic. Z. Dai: Employee; Metronics. F. Niu: None. J. Shin: Employee; Medtronic. T.L. Cordero: Employee; Medtronic. J.J.F. McVean: Employee; Medtronic.

Introduction and Objective: The area deprivation index (ADI) score is a composite metric of socioeconomic status ranging from 1-30 (least deprived) to 80-100 (most deprived), which is based on income, housing, employment, and education.1 As a higher ADI has been associated with increased dysglycemia,2 the present study assessed real-world MiniMed™ 780G glycemic outcomes across the United States (U.S.) ADI. Methods: CareLink™ personal data (as of October 26, 2024) of 39,387 consenting MM780G users, who lived in the U.S. and had ≥10 days of sensor use, were assessed. Glycemic metrics, insulin, and achieved glycemic targets were stratified from lowest to highest ADI. Metrics included the mean glucose management indicator (GMI) and time within 70-140 mg/dL (TITR), within 70-180 mg/dL (TIR), below 70 mg/dL (TBR) and above 180 mg/dL (TAR). Results: From the lowest to highest ADI, MM780G ROS use (~30%), AHCL use (~87%), and glycemic control trended similarly (Figure). The proportion of users achieving consensus-recommended GMI, TIR and TBR averaged 50%-53%. Conclusion: These data demonstrate that independent of socioeconomic status, a majority of MiniMed™ 780G system users in the U.S. were able to meet consensus glycemic targets. J.J.F. McVean: Employee; Medtronic. Z. Dai: Employee; Metronics. M. Liu: Employee; Medtronic. N. Sathiyanathan: None. V. Putcha: Employee; Medtronic. Stock/Shareholder; Medtronic. A. Kinnischtzke: None. J. Shin: Employee; Medtronic. T.L. Cordero: Employee; Medtronic. R.A. Vigersky: Employee; Medtronic.

Introduction and Objective: The MiniMed™ 780G system (MM780G) safe meal bolus (SMB) reduces the meal bolus amount when post-prandial hypoglycemia is predicted over the ensuing 4 hours. We have shown that the sensor glucose (SG) rate-of-change (ROC) immediately prior to meal bolus has a significant inverse relationship with the amount of insulin delivered.1 The present analysis evaluated the relationship of SMB reduction as a function of modifiable factors (e.g., user input of carbohydrates [CHO] and insulin-to-carb ratio [ICR]) and non-modifiable factors (e.g., ROC and age). Methods: We examined 9 months of CareLink™ data from consenting US MM780G users (N=44,725) ≥18 years (541,243 meals), with baseline SG 100-120mg/dL at mealtime (when no autocorrection was triggered), and excluded CHO input >175g (<0.5% of sample). Metrics were averaged per person. Results: The % of SMB insulin reduction had an inverse relationship with CHO, ICR, ROC and age (Table). Conclusion: Multiple factors determine the % of SMB insulin reduction. There is a strong inverse correlation with CHO when there is a high risk for hypoglycemia. Conjointly, CHO, ICR and ROC factors mitigate the likelihood of PP hypo- and/or hyperglycemia with an appropriate reduction of meal bolus allowing international consensus-recommended targets to be met, even with variable CHO inputs. V. Putcha: Employee; Medtronic. Stock/Shareholder; Medtronic. A. Benedetti: None. A. Roy: Employee; Metronics. L.J. Lintereur: Employee; Medtronic. B. Grosman: Employee; Medtronic. K. Turksoy: None. A. Kinnischtzke: None. D. Miller: Employee; Medtronic. T.L. Cordero: Employee; Medtronic. J. Shin: Employee; Medtronic. R.A. Vigersky: Employee; Medtronic.