Use In Neonatology Research Articles

Development and Optimization of Nasal Composition of a Neuroprotective Agent for Use in Neonatology after Prenatal Hypoxia.

The intranasal route of drug administration is characterized by high bioavailability and is considered promising for rapid delivery of drugs with systemic action to the central nervous system (CNS), bypassing the blood-brain barrier. This is particularly important for the use of neuroprotective drugs in the treatment of brain tissue damage in infants caused by the effects of intrauterine hypoxia. The creation of new dosage forms for neonatology using mathematical technologies and special software in pharmaceutical development allows for the creation of cerebroprotective drugs with controlled pharmaco-technological properties, thus reducing time and resources for necessary research. We developed a new nasal gel formulation with Angiolin using a Box-Behnken experiment design for the therapy of prenatal CNS damage. It was found that the consistency characteristics of the nasal gel were significantly influenced by the gelling agent and mucoadhesive component-sodium salt of carboxymethylcellulose. We optimized the composition of nasal gel formulation with Angiolin using the formed models and relationships between the factors. The optimized nasal gel composition demonstrated satisfactory thixotropic properties. The 1% gel for neuroprotection with Angiolin, developed for intranasal administration, meets all safety requirements for this group of drug forms, showing low toxicity and no local irritant or allergic effects.

Portable point-of-care surface enhanced Raman scattering spectroscopy for the quantification of glutathione in whole blood microsamples

Glutathione (GSH) is a non-protein tripeptide thiol that plays a prominent role in oxidative stress defense. GSH concentration is particularly critical in the neonatal period, especially for premature newborns that face increased susceptibility to oxidative stress. Monitoring GSH levels provides valuable insights into newborn health, helping to tailor care to their specific needs. The aim of this study was the development of a sensor specifically targeted for its use in neonatology, enabling GSH determination in only 2 μL of whole blood. The newly developed sensing system simplifies sample processing, addressing a critical need in clinical applications. Unlike current methods that demand fast pre-processing of relatively large sample volumes, expensive equipment, and skilled personnel, the developed approach streamlines the analytical process. By using 2 μL of whole blood, a single syringe filter for sample treatment, a deuterated internal standard (IS) for signal normalization, and Surface Enhanced Raman Scattering (SERS) spectroscopy with a silver colloid substrate for GSH detection, the set-up's characteristics are compatible with point-of-care applications. The analytical procedure was validated and applied to diverse populations including healthy adults (N = 63) and newborns (N = 35), yielding GSH concentration values ranging from 0.6 to 1.8 and 0.8–2.1 mM, respectively. This new optical sensor offers a quick and cost-effective solution to support the assessment of GSH levels in newborns that can greatly benefit not only neonatal care, but also the study of adult populations for health monitoring.

Growth charts for use at birth and in the neonatal period: Recommendations of the French Neonatal Society.

The use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth). (1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France. Bibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies. Antenatal information about fetal growth restriction or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the World Health Organization charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants. The updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns.

Fresh Frozen Plasma Administration in the NICU: Evidence-based Guidelines.

The use of FFP in neonatology should be primarily for neonates with active bleeding and associated coagulopathy. However, since there is limited and poor-quality evidence supporting neonatal FFP transfusion, considerable FFP usage continues to be outside of this recommendation, as documented by neonatal transfusion audits. This review updates the scientific evidence available on FFP use in neonatology and reports the best evidence-practice for the safety of neonates receiving FFP.

Compounded medications for cardiovascular use in neonatology: an integrative review.

ABSTRACTObjective:To analyze the profile of the compounded cardiovascular medicines prescribed in neonatology in Brazil.Data source:An integrative bibliographic review was carried out, including studies published in the last 20 years. The used descriptors were: Intensive Care Neonatal, Off-Label Use, Pharmaceutical Preparations, in the databases Virtual Health Library (VHL), PubMed, and Scientific Electronic Library Online (SciELO). Review articles and guidelines were excluded. The quality of the evidence was analyzed, and 10 articles were selected to integrate the study.Data synthesis:The profile of routine prescrption in the neonatal unit was evaluated. The main cardiovascular medications prescribed as compounding formulation were: Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. The drugs were obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations, as a solution, suspension, or syrup, as well as in the form of solutions prepared from active pharmaceutical ingredients. The compounding of medications made drug therapy possible in neonatology, considering that such medications do not have registration of the oral liquid dosage form in the country, despite being part of the List of Essential Medicines for Children of the Word Health Organization.Conclusions:It was possible to analyze the profile of compounded cardiovascular medicines prescribed in neonatology in Brazil. The results showed the need for the development of medications suitable for the neonatal population, and the standardization of operational procedures for preparing extemporaneous formulations in neonatology to increase drug safety.

Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes.

Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes. In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation. Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved. This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.

Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes

Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the treating clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS may be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing the quality of care and improving outcomes. In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees, as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is also widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada, and recently, the Royal College of Physicians and Surgeons (Canada) recognized targeted neonatal echocardiography performed by the neonatologist as area of focus competency for certification. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation. Recently, the first international, evidence-based POCUS guidelines for the use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved. This clinical report describes the current landscape of neonatal POCUS, outlines barriers for implementation, and provides a suggested educational framework and overall strategy for successful implementation of a POCUS program. Diagnostic and procedural applications of POCUS in the NICU will be explored in detail in the accompanying technical report, which can be found in this issue of Pediatrics.

Ultrasound for Endotracheal Tube Tip Position in Term and Preterm Infants

Background and Objective: Placing an endotracheal tube (ETT) in neonates is challenging and currently requires timely radiographic confirmation of correct tip placement. The objective was to establish the reliability of ultrasound (US) for assessing ETT position in the neonatal intensive care unit (NICU), time needed to do so, and patients’ tolerance. Methods: A prospective study on 71 newborns admitted to our NICU whose ETT placement was evaluated with US (ETT-echo) and confirmed on chest X-rays (CXR). Data were collected by 3 operators (2 neonatologists and a resident in pediatrics). The right pulmonary artery (RPA) was used as a landmark for US. The distance between the tip of the ETT and the upper margin of the RPA was measured using US and compared with the distance between the tube’s tip and the carina on the CXR. Results: Seventy-one intubated newborns were included in the study (n = 34 < 1,000 g, n = 18 1,000–2,000 g, n = 19 > 2,000 g). Statistical analysis (Bland-Altman plot and Lin’s concordance correlation coefficient) showed an excellent consistency between ETT positions identified on US and chest X-ray. The 2 measures (ETT-echo and CXR) were extremely concordant both in the whole sample and in the subgroups. Minimal changes in patients’ vital signs were infrequently observed during US, confirming the tolerability of ETT-echo. The mean time to perform US was 3.2 min (range 1–13). Conclusions: ETT-echo seems to be a rapid, tolerable, and highly reliable method worth further investigating for future routine use in neonatology with a view to reducing radiation exposure.

Continuous Glucose Monitoring in the Management of Neonates With Persistent Hypoglycemia and Congenital Hyperinsulinism.

BackgroundPersistent hypoglycemia is common in the newborn and is associated with poor neurodevelopmental outcome. Adequate monitoring is critical in prevention, but is dependent on frequent, often hourly blood sampling. Continuous glucose monitoring (CGM) is increasingly being used in children with type 1 diabetes mellitus, but use in neonatology remains limited. We aimed to introduce real-time CGM to provide insights into patterns of dysglycemia and to support the management of persistent neonatal hypoglycemia.MethodsThis is a single-center retrospective study of real-time CGM use over a 4-year period in babies with persistent hypoglycemia.ResultsCGMs were inserted in 14 babies: 8 term and 6 preterm infants, 9 with evidence of congenital hyperinsulinism (CHI). A total of 224 days of data was collected demonstrating marked fluctuations in glucose levels in babies with CHI, with a higher sensor glucose SD (1.52 ± 0.79 mmol/L vs 0.77 ± 0.22 mmol/L) in infants with CHI compared with preterm infants. A total of 1254 paired glucose values (CGM and blood) were compared and gave a mean absolute relative difference of 11%.ConclusionCGM highlighted the challenges of preventing hypoglycemia in these babies when using intermittent blood glucose levels alone, and the potential application of CGM as an adjunct to clinical care.

P1828A PANEL OF URINE BIOMARKERS FOR EARLY KIDNEY INJURY DETECTION IN NEWBORNS

Abstract Background and Aims Neonatal kidney damage is a wide spread pathology, especially among preterm infants. Acute kidney injury (AKI) in newborns remains one of the most important problems because the features of neonatal nephrogenesis and physiology. The current clinical criteria for the diagnosis of AKI, including pediatric scales pRIFLE and nRIFLE, rely on glomerulal filtration rate (GFR), blood urea nitrogen (BUN), and serum creatinine (SCr), which are the late biomarkers detectable only within days or weeks after kidney damage occurred, and therefore have limitations when used within the first days after birth. Therefore, sensitive and specific tests for early diagnostics of kidney injury are extremely needed in neonatology. Urine biomarkers appear to be promising for early diagnosis of AKI. Quite often renal pathologies result in markedly increased (or decreased) urinary excretion of a number of protein biomarkers, indicating subclinical tubular injury while conventional AKI signs are not manifested yet. The aim of this study was to determine clinical value of urine molecular biomarkers for the prediction of acute kidney injury in newborns. Method Urine samples from newborns with congenital malformation were collected on the 1st day after born, and then once a week until the 21th postnatal day. Urine samples were centrifuged, aliquoted and stored at –80°С until testing. The next urinary biomarkers were analyzed: calbindin 1, clusterin, IL-18, KIM-1, GST-π, MCP-1 and NGAL. Quantitative determination was performed with immunoassay kit Bio-Plex Pro™ RBM Human Kidney Toxicity Panel 1 (Bio-Rad Inc., USA) and Human NGAL ELISA kit (Invitrogen, Germany). Control group included five age-matched healthy infants. Results 8 of 20 patients showed a direct correlation of increased NGAL levels in urine (50-fold compared to control group) with high levels of C-reactive protein in the blood (3-10-fold rise above the reference level). NGAL is the most sensitive marker for assessing AKI or tubular damage. These 8 patients were further investigated for other urine biomarkers. The IL-18 level in urine was slightly increased in 4 patients. IL-18 is proposed to be a predictor for AKI severity and mortality in children with critical illness. KIM-1 has low basal expression in the normal kidney but its appearance is highly specific and sensitive sign for nephrotoxicity in proximal tubules. We observed the increase of KIM-1 urinary excretion for 7 patients. However, we discover the equal occurrence of decrease or increase of urine MCP-1 through studied patients. Elevated levels of urine MCP-1 were earlier observed in experimental maleate induced azotemia, LPS injection and in model of unilateral ureteral obstruction (UUO). An increase of KIM-1 and/or MCP-1 urinary excretion is known to be associated with some risk of AKI development. We found 3-fold growth of urine clusterin in 7 children. It is noticed, that clusterin increased in damaged tubular cells during polycystic kidney disease and renal carcinoma. Additionally, we revealed 7-fold decrease of calbindin 1 in urine of 7 patients. Сalbindin 1 exclusively localized in the kidney distal nephron segment, and its decrease was discribed for models of UUO, glomerulonephritis and cisplatin nephropathy. GST-π protein is found in cells lining the lumen of the distal tubules and is elevated in the urine of patients with sepsis, independently of accompanied AKI. We also observed 10- to 20-fold rising of urine GST-π for all 8 NGAL-positive newborns. Conclusion The specificity, rate of increase, and non-invasive detection of urine markers studied in this work, make them indispensable in clinical practice. However, their use in neonatology is still experimental. We showed potential applicability of wide biomarker panel for early detection and prediction of AKI in newborns.

AEEG Use in Pediatric Critical Care-An Online Survey.

Background: Evidence supporting continuous EEG monitoring in pediatric intensive care is increasing, but continuous full-channel EEG is a scarce resource. Amplitude-integrated EEG (aEEG) monitors are broadly available in children's hospitals due to their use in neonatology and can easily be applied to older patients.Objective: The aim of this survey was to evaluate the use of amplitude-integrated EEG in German and Swiss pediatric intensive care units (PICUs).Design: An online survey was sent to German and Swiss PICUs that were identified via databases provided by the German Pediatric Association (DGKJ) and the Swiss Society of Intensive Care (SGI). The questionnaire contained 18 multiple choice questions including the PICU size and specialization, indications for aEEG use, perceived benefits from aEEG, and data storage.Main results: Forty-three (26%) PICUs filled out the questionnaire. Two thirds of all interviewed PICUs use aEEG in non-neonates. Main indications were neurological complications or disease and altered mental state. Features assessed were mostly seizures and side differences, less frequently height of amplitude and background pattern. Interpretation of raw EEG also played an important role. All interviewees would appreciate the establishment of reference values for toddlers and children.Conclusions: aEEG is used in a large proportion of the interviewed PICUs. The wide-spread use without validation of data generates the need for further evaluation of this technique and the establishment of reference values for non-neonates.

Protein and peptide profiles in neonatal meconium.

The proteins accumulated in the meconium reflect the intrauterine environment and are naturally excreted by a neonate. The identification and classification of individual meconium proteins may be a valuable source of information about physiological and pathological processes in utero. Proteomic analysis was used to study the protein composition in pooled 50 serial meconium portions from 10 neonates. The proteins were classified based on the gene ontology database. The amounts and relative number of proteins (%) in the identified categories and their subcategories were assessed. A total of 946 proteins identified in meconium, including 430 represented by two or more peptides were classified into three categories: biological process (n = 401), molecular function (n = 386) and cellular component (n = 422). The highest number of proteins (>25% of the total) was found in the subcategories: developmental processes, signaling, transport, response to stimulus, regulation, metabolic processes, ion binding, extracellular region, membrane and cytoplasm. The composition of meconium proteins identified in this study may be a rich source of new biomarkers for use in neonatology with a potential to predict later development.

Assessing Ethics Knowledge: Development of a Test of Ethics Knowledge in Neonatology

To develop and validate the Test of Ethics Knowledge in Neonatology (TEK-Neo) with good internal consistency reliability, item performance, and construct validity that reliably assesses interprofessional staff and trainee knowledge of neonatal ethics. We adapted a published test of ethics knowledge for use in neonatology. The novel instrument had 46 true/false questions distributed among 7 domains of neonatal ethics: ethical principles, professionalism, genetic testing, beginning of life/viability, end of life, informed permission/decision making, and research ethics. Content and correct answers were derived from published statements and guidelines. We administered the voluntary, anonymous test via e-mailed link to 103 participants, including medical students, neonatology fellows, neonatologists, neonatology nurses, and pediatric ethicists. After item reduction, we examined psychometric properties of the resulting 36-item test and assessed overall sample performance. The overall response rate was 27% (103 of 380). The test demonstrated good internal reliability (Cronbach α = 0.66), with a mean score of 28.5 ± 3.4 out of the maximum 36. Participants with formal ethics training performed better than those without (30.3 ± 2.9 vs 28.1 ± 3.5; P = .01). Performance improved significantly with higher levels of medical/ethical training among the 5 groups: medical students, 25.9 ± 3.7; neonatal nurses/practitioners, 27.7 ± 2.7; neonatologists, 28.8 ± 3.7; neonatology fellows, 29.8 ± 2.9; and clinical ethicists, 33.0 ± 1.9 (P < .0001). The TEK-Neo reliably assesses knowledge of neonatal ethics among interprofessional staff and trainees in neonatology. This novel tool discriminates between learners with different levels of expertise and can be used interprofessionally to assess individual and group performance, track milestone progression, and address curricular gaps in neonatal ethics.

Novel free-radical mediated lipid peroxidation biomarkers in newborn plasma

Oxidative stress derived from perinatal asphyxia appears to be closely linked to neonatal brain damage and lipid peroxidation biomarkers have shown to provide predictive power of oxidative stress related pathologies in situations of hypoxia and reoxygenation in the newborn. The objective of this work was to develop and validate of a comprehensive liquid chromatography tandem mass spectrometry approach for the quantitative profiling of 28 isoprostanoids in newborn plasma samples covering a broad range of lipid peroxidation product classes. The method was developed taking into account the specific requirements for its use in neonatology (i.e. limited sample volumes, straightforward sample processing and high analytical throughput). The method was validated following stringent FDA guidelines and was then applied to the analysis of 150 plasma samples collected from newborns. Information obtained from the quantitative analysis of isoprostanoids was critically compared to that provided by a previously developed approach aiming at the semi-quantitative detection of total parameters of fatty acid derived lipid peroxidation biomarkers.

Padovan Method Of Neurofunctional Reorganization As A Way For Neurological Recovery In Newborns

Introduction: The physiological basis of neurofunctional reorganization in stimulating the nervous system is justified and ratified by the concepts of neuroplasticity and therefore, its use in neonatology is well indicated.Objective: Describe how Neurofunctional reorganization through Padovan method can contribute to restore neurologic function of newborns and can avoid the need for gastrostomy and shortening hospital stay. Method: Descriptive and retrospective study performed in a hospital at Ceará´s inland, Brazil, through analysis of medical records. 92 patients from the neonatal ICU who suffered perinatal asphyxia and evolved with neurological disorders were evaluated. Patients received Neurofunctional Reorganization therapy, which is the performance of physical and oral exercises that complement each other in order to recover lost functions and also prepare the body to acquire functions and capabilities which it has potential for. Results: Eighty-two patients completed the therapy and showed positive results (89.1%). The main expected outcome was the recovery of suction and this was achieved in between 8 and 150 days. 48 cases showed an improvement between 8 and 30 days of treatment (56%). Conclusions: The Neurofunctional reorganization proposed by Padovan is effective in the recovery of neurological function of newborns, especially the suction, shortening the hospital stay and avoiding gastrostomy.

Training of Ultrasound in Neonatology: Global or Local?

ABSTRACT From the beginning of its use in neonatology, ultrasound is used more frequently and for many indications. Number of indications is increasing from year to year, while the training opportunities and curricula are not following the same trend. Nowadays ultrasound has been used for determination of functional hemodynamics in critically sick neonates which increases educational burden on the young neonatologists. This only applies to the developed countries where neonatology is well developed, while in low income so called developing countries some basic health problems of neonates have not been solved and there is substantial lack of health care professionals and equipment as well. How to cite this article Stanojevic M. Training of Ultrasound in Neonatology: Global or Local? Donald School J Ultrasound Obstet Gynecol 2013;7(3):338-345.

Prospective evaluation of three point of care devices for glycemia measurement in a neonatal intensive care unit

Hypoglycemia, if recurrent, may have severe consequences on cognitive and psychomotor development of neonates. Therefore, screening for hypoglycemia is a daily routine in every facility taking care of newborn infants. Point-of-care-testing (POCT) devices are interesting for neonatal use, as their handling is easy, measurements can be performed at bedside, demanded blood volume is small and results are readily available. However, such whole blood measurements are challenged by a wide variation of hematocrit in neonates and a spectrum of normal glucose concentration at the lower end of the test range. We conducted a prospective trial to check precision and accuracy of the best suitable POCT device for neonatal use from three leading companies in Europe. Of the three devices tested (Precision Xceed, Abbott; Elite XL, Bayer; Aviva Nano, Roche), Aviva Nano exhibited the best precision. None completely fulfilled the ISO-accuracy-criteria 15197: 2003 or 2011. Aviva Nano fulfilled these criteria in 92% of cases while the others were <87%. Precision Xceed reached the 95% limit of the 2003 ISO-criteria for values ≤4.2mmol/L, but not for the higher range (71%).Although validated for adults, new POCT devices need to be specifically evaluated on newborn infants before adopting their routine use in neonatology.

Stability of diluted epinephrine in prefilled syringes for use in neonatology

ObjectivesThe purpose of this study was to determine the chemical stability and sterility of a diluted, ready-to-use solution of epinephrine for premature neonatal emergencies.MethodsA commercially available preparation of epinephrine (1...

Understanding Near-Infrared Spectroscopy

Near-infrared spectroscopy (NIRS) is a noninvasive technique that monitors regional tissue oxygenation reflecting perfusion status. Near-infrared spectroscopy has the ability to continuously and simultaneously monitor tissue perfusion in different organ systems at the bedside without interrupting routine care. Research has demonstrated its benefit in monitoring cerebral, intestinal, and renal perfusion to detect potential ischemic episodes. Near-infrared spectroscopy can augment current physiologic monitoring to increase awareness of abnormal perfusion status in the preterm population and potentially reduce risks associated with many diseases that may lead to ischemic injury. This article provides an overview describing NIRS technology and function, its current use in neonatology, and pertinent research findings illustrating its benefit in the neonatal population. Near-infrared spectroscopy may evolve into an important diagnostic and prognostic tool for neonatal treatment and outcome.

Little Babies with Little Numbers: the Significance of Thrombocytopenia in Neonatal Intensive Care

Neonatal thrombocytopenia and bleeding are common and important clinical problems in neonatology affecting 25% of all neonatal unit admissions. Platelet transfusions are frequently used in modern neonatal clinical practice as prophylaxis in thrombocytopenic neonates. Policies and protocols for neonatal platelet transfusion therapy vary widely between clinicians and institutions, reflecting the generally broad nature of recommendations in national guidelines, which themselves are based largely on consensus rather than evidence and often extrapolated from adult data. Recent randomised trials addressing red cell transfusion triggers for anaemic neonates have contributed to the debate on appropriate neonatal red cell transfusions. However, a comparable platelet trigger trial, assessing clinically relevant outcomes, has never been undertaken in preterm neonates with severe thrombocytopenia (platelet counts< 50 x109/L). There have been concerns about adverse reactions to platelet transfusions in neonates with reports suggesting an association between repeated platelet transfusions and adverse events such as necrotising enterocolitis and sepsis. The risk of bacterial contamination is estimated at 15 per million donations but platelets are the blood component most likely to be contaminated by bacteria as they are stored at room temperature. This lecture will cover the existing evidence governing platelet transfusion practice in neonatology and outline proposed research in the area. The development of a dedicated neonatal bleeding assessment tools for use in neonatology in conjunction with platelet threshold trials will be discussed.