Neonatal transfusion practice.(Personal Practice)

Arch Dis Child Fetal Neonatal Ed 2004;89:F101-F107. doi: 10.1136/adc.2002.019760

Many previously widely accepted neonatal transfusion practices are changing as neonatologists become more aware of the risks to their patients of multiple blood product transfusions. Recent literature and research on neonatal transfusion practice are here reviewed, and practical guidelines and trigger thresholds for blood products commonly used in neonatal medicine are proposed.

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Sick neonates are one of the most heavily transfused groups of patients in modern medicine. However, despite considerable research, most neonatal transfusion practice remains opinion based rather than truly evidence based. Most neonatologists would not prescribe drugs to their patients unless there was a reasonable expectation of benefit. Unfortunately, this rigour does not translate to the prescription of blood products, and as a result there exists a diversity of opinion and practice between different clinicians (1) and different institutions. (2-6) Clearly the administration of blood products conveys a finite risk of transmitting potentially serious infections (7-9) and is not without risk and cost. (7 8) It therefore remains a continuing task to define and refine the most clinically appropriate protocols for blood product use in neonates, within the constraints of the available evidence. With these goals in mind this paper reviews recent literature and research on neonatal transfusion practice and proposes practical transfusion guidelines and trigger thresholds for commonly used blood products in neonatal medicine.

RED BLOOD CELLS

Packed red blood cells (RBCs) are the most common blood product administered to sick neonates. Many previous studies (reviewed in refs (10 11)) have attempted to define their optimal use in neonates. However, rapidly changing patient populations and characteristics over the last decade, coupled with the introduction of increasingly rigorous transfusion protocols, have reduced the relevance of much of this previous work to modern neonatal practice. Progress in RBC transfusion practice therefore requires a fundamental re-evaluation of its basic aims.

At the most basic level, RBC transfusions are required for two reasons: