Red Blood Cell Transfusion Practice Pattern Before and After Implementation of a Local Restrictive Transfusion Protocol in a Neonatal Intensive Care Unit

Abstract

Background A restrictive red blood cell (RBC) transfusion guideline was established in 2019 in a neonatal intensive care unit (NICU), suggesting a hemoglobin concentration threshold of 7 g/dL. Objectives (a) To determine its impact on the number of RBC transfusions and donor exposure; (b) to characterize RBC-transfusion determinants and justifications. Study Design Single-center retrospective historical control study comparing all neonates consecutively admitted to the NICU during two five-month periods: 401 patients in 2013 before and 402 patients in 2021 after restrictive guideline implementation. Possible determinants were assessed via logistic regressions and justifications via a questionnaire. Results In 2021, 9.2% of neonates received at least one RBC transfusion compared to 13.5% in 2013 ( p = .075). Adherence to protocol thresholds was 50%. Implementation of a restrictive transfusion protocol had some impact on determinants related to neonatal morbidity and illness severity and some impact on justifications being mainly based on hemoglobin value. Conclusion Our study demonstrates that the implementation of a restrictive RBC transfusion protocol tended to decrease transfusion rates and donor exposure in the NICU, but the trend was not statistically significant. Future work should focus on improving protocol adherence.