Abstract
Transfusions of red blood cells (RBCs), platelets, and plasma are critical therapies for infants and neonates (particularly preterm neonates) in the neonatal intensive care unit, who are the most frequently transfused subpopulation across all ages. Although traditionally a significant gap has existed between the blood utilization and the evidence base essential to adequately guide transfusion practices in infants and neonates, pediatric transfusion medicine is evolving from infancy and gradually coming of age. It is entering an exciting era with recognition as an independent discipline, a new and evolving high-quality evidence base for transfusion practices, novel technologies and therapeutics, and national/international collaborative research, educational, and clinical efforts. Triggers and thresholds for red cell transfusion are accumulating evidence with current phase III clinical trials. Ongoing trials and studies of platelet and plasma transfusions in neonates are anticipated to provide high-quality evidence in years to come. This article aims to summarize the most current evidence-based practices regarding blood component therapy in neonates. Data on the use of specific components (RBCs, plasma, and platelets) are provided. We attempt to define thresholds for anemia, thrombocytopenia, and abnormal coagulation profile in neonates to highlight the difficulties in having a specific cutoff value in neonates and preterm infants. Indications for transfusion of specific products, transfusion thresholds, and current practices and guidelines are provided, and possible adverse outcomes and complications are discussed. Finally, the critical research knowledge gaps in these practices as well as ongoing and future research areas are discussed. In an era of personalized medicine, neonatal transfusion decisions guided by a strong evidence base must be the overarching goal, and this underlies all of the strategic initiatives in pediatric and neonatal transfusion research highlighted in this article.
Highlights
Blood transfusions can be critical supportive therapy for infants and neonates who are frequently transfused[1,2]. During their stay in the neonatal intensive care unit (NICU), the majority of extremely low-birth-weight (ELBW) infants receive at least one red blood cell (RBC) transfusion and many end up receiving multiple transfusions
A more updated meta-analysis published recently which addresses the same question from 17 observational studies showed no temporal relationship between RBC transfusions and NEC23
Research gaps and ongoing and future research in red blood cell transfusions in neonates The majority of research studies far are limited by a small sample size; observational, retrospective, or a case-control design; or a lack of evaluation of time-varying exposures to study various outcomes. This underscores the need for prospective studies in which each documentation of anemia, subsequent RBC transfusion, and a specific outcome of interest can be prospectively and systematically evaluated[27]
Summary
Blood transfusions can be critical supportive therapy for infants and neonates ( preterm neonates) who are frequently transfused[1,2]. Research gaps and ongoing and future research in red blood cell transfusions in neonates The majority of research studies far are limited by a small sample size; observational, retrospective, or a case-control design; or a lack of evaluation of time-varying exposures to study various outcomes This underscores the need for prospective studies in which each documentation of anemia, subsequent RBC transfusion, and a specific outcome of interest can be prospectively and systematically evaluated[27]. Besides studies of the platelet transfusion threshold, studies are needed to characterize the overall platelet function and the global hemostatic profile of neonates, especially preterm infants, as well as the use of thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor hemostatic treatment to better predict their bleeding risk and direct prophylactic or therapeutic measures for IVH/PVH50. Grant information The author(s) declared that no grants were involved in supporting this work
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