Transfusion of red blood cells and platelets are commonly performed on
neonates in the neonatal intensive care unit (NICU). Transfusions in the neonatal population are
associated with higher mortality and morbidity when compared to the adult
population. Known risks of transfusions
include alloimmunization, transfusion reactions and transmission of
infections. It has also been suggested
that necrotizing enterocolitis (NEC) or intraventricular hemorrhage (IVH) may
occur in neonates following a red blood cell transfusion. These risks must be balanced against clinical
need, especially in the neonatal population.
Unfortunately, few clinical trials have been performed to establish
guidelines for neonatal transfusions.
For this reason, transfusion practices and guidelines widely vary and
are sometimes controversial. This
article overviews the need for improving transfusion practices by establishing
NICU transfusion guidelines.
Current practices involve red cell transfusions that are guided by the
neonate’s hematocrit level. The authors
of this article suggest using more restrictive transfusion hemoglobin
thresholds when deciding if transfusion is necessary. The suggested transfusion hemoglobin at 1-7
days old is