The practice of transfusion and fluid bolus therapy in neonates

Abstract

There is increasing uncertainty over the potential benefits and harms of volume expansion in paediatric and adult critical care settings. In addition, there are increasing numbers of reports of adverse effects and association with RBC transfusions in neonates, including transfusion‐associated necrotizing enterocolitis. Preterm infants <28 weeks’ gestation in particular are likely more vulnerable to volume shifts and changes in blood pressure due to their unique physiology. This review paper will provide an overview of the current evidence base supporting the use of RBC transfusion thresholds and the use of fluid bolus therapy in neonates. We will argue that enhanced data collection and collaborations through neonatal networks, development of international consensus definitions of transfusion adverse effects and associations, as well as haemodynamic compromise in neonates, are needed to further advance research in these areas.