Platelet transfusion practices among neonatologists in the United States and Canada: results of a survey.
OBJECTIVE
In the absence of scientific evidence, current neonatal platelet transfusion practices are based on physicians' preferences, expert advice, or consensus-driven recommendations. We hypothesized that there would be significant diversity in platelet transfusion triggers, product selection, and dosing among neonatologists in the United States and Canada.


METHODS
A Web-based survey on neonatal platelet transfusion practices was distributed to all members of the American Academy of Pediatrics Perinatal Section in the United States and to all physicians listed in the 2005 Canadian Neonatology Directory.


RESULTS
The overall response rate was 37% (1060 of 2875). In the United States, 37% (1007 of 2700) responded, of which 52% practiced at academic centers. Thirty percent (53 of 175) of Canadians responded, of whom 94% practiced at academic centers. As hypothesized, there was significant practice diversity in both countries. The survey also revealed that platelet transfusions are frequently administered to nonbleeding neonates with platelet counts of >50 x 10(9)/L. This practice is particularly prevalent among neonates with specific clinical conditions, including indomethacin treatment, preceding procedures, in the postoperative period, or with intraventricular hemorrhages.


CONCLUSIONS
There is great variability in platelet transfusion practices among US and Canadian neonatologists, suggesting clinical equipoise in many clinical scenarios. Prospective randomized clinical trials to generate evidence-based neonatal platelet transfusion guidelines are needed.
Josephson
Cassandra D
CD
Aflac Cancer Center and Blood Disorders Services at Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Su
Leon L
LL
Christensen
Robert D
RD
Hillyer
Christopher D
CD
Castillejo
Marta-Inés
MI
Emory
Michele R
MR
Lin
Yulia
Y
Hume
Heather
H
Easley
Kirk
K
Poterjoy
Brandon
B
Sola-Visner
Martha
M
D002170:Canada; D003625:Data Collection / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D009359:Neonatology / Q000379:methods* / Q000592:standards; D010820:Physicians / Q000592:standards; D010976:Platelet Count / Q000592:standards; D017713:Platelet Transfusion / Q000379:methods* / Q000592:standards; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000097:blood / Q000628:therapy; D014481:United States