Abstract
Based on small studies and not on statistically valid clinical trials, guidelines
for neonatal transfusions remain controversial and practices vary greatly. Premature
infants and critically ill neonates in the neonatal intensive care unit (NICU) often
require blood transfusions and extremely preterm neonates receive at least one red
blood cell transfusion during their hospital stay. Transfusions to neonates convey
both benefits and risks and consequently it is imperative to establish specific guidelines
to improve practice and avoid unnecessary transfusions. Appropriate and lifesaving
platelet transfusion in thrombocytopenic bleeding neonates pertains to 2% of all neonates
in NICUs. Inversely, 98% of platelet transfusions are given prophylactically, in the
absence of bleeding, with the assumption that this reduces the risk of a serious hemorrhage.
To date, no evidence base is available for assigning a platelet transfusion trigger
to NICU patients. Each NICU should approve specific guidelines that best suit its
local clinical practice. Therefore, whatever guidelines are chosen in deciding when
to transfuse, what is most important is to adhere strictly to the guidelines adopted,
thus limiting unnecessary transfusions that convey no benefits and carry both known
and unknown risks.
Keywords
neonatal transfusion - red blood cells - neonatal anemia - thrombocytopenic
