Transfusion in Neonatal Patients: Review of Evidence-Based Guidelines

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Key points

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    Transfusion recommendations in neonatal patients are less defined by evidence-based guidelines than those in older children and adults.

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    When making the decision to transfuse a neonate, clinicians should consider physiologic differences of this age group, gestational and postnatal age, congenital disorders, and maternal factors.

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    Anemia and thrombocytopenia are highly prevalent in preterm neonates, and the risks versus benefits of transfusion must be weighed carefully in this vulnerable population.

Term Neonates

When making the decision to transfuse during the neonatal period, it is important to understand fetal and neonatal hematopoiesis. Hemoglobin concentration increases progressively throughout gestation and peaks after birth. Full-term neonates have hemoglobin values of 16 to 17 g/dL at term, which may increase by 1 to 2 g/dL because of placental transfusion at birth and may vary depending on timing of cord clamping. There is a gradual decline in hemoglobin concentration to a nadir of 11 to

Neonatal red blood cell transfusion

RBC transfusion is a critical intervention to increase oxygen-carrying capacity in anemic neonates. In addition to severe anemia, indications for transfusion in the early neonatal period can include acute blood loss, hypotension, hypovolemia, or to improve oxygen-carrying capacity in infants with respiratory failure.14 Although often lifesaving, transfusions also have the potential to cause adverse effects, including hemolytic transfusion reactions, alloimmunization, infections, volume

Thrombocytopenia in Neonates

Thrombocytopenia is common in neonates, and can affect an estimated 1% to 2% of otherwise healthy newborns. Critically ill neonates have an even higher rate of thrombocytopenia, with 20% to 35% having platelets counts of less than 150,000/μL.77 The incidence increases with decreasing gestational age, with approximately 70% of VLBW neonates experiencing thrombocytopenia.77,78 The differential diagnosis of thrombocytopenia in neonates is broad, and includes intrauterine infection, placental

Neonatal plasma transfusion

Plasma transfusion in neonates is often used incorrectly.111, 112, 113, 114, 115, 116 In part, this may be because of the lack of evidence-based guidelines available to guide transfusion of FFP in the pediatric patient population. It is essential to determine the clinical scenarios in neonates that require transfusion of plasma and to differentiate those in which an alternative product, such as a specific factor concentrate, should be used. Of note, in the absence of bleeding, plasma should not

Disclosure

The authors have nothing to disclose.

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    Funding: This work was supported in part by funding from P01 HL046925 to C. Josephson. Additional funding was from the NICHD Child Health Research Career Development Award Program, K12HD072245, Atlanta Pediatric Scholars Program to P.E. Zerra.

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