title: Platelet transfusions in neonates: practices in the United States vary significantly from those in Austria, Germany, and Switzerland.
abstract: BACKGROUND
  Thrombocytopenia affects 20% to 35% of patients admitted to neonatal intensive care units (NICUs). Platelet (PLT) transfusions are usually administered to neonates with thrombocytopenia at higher thresholds than those used for older children or adults, although there is a paucity of evidence to guide these decisions.
  
  
  METHODS
  In this study, we used a Web-based survey to investigate the PLT transfusion thresholds used in Level 1 NICUs (equivalent to Level 3 in the US) in three European countries (Austria, Germany, and Switzerland [AUT/GER/SUI]). This survey was identical to the one that was previously sent to US neonatologists, thus allowing for a direct comparison of their responses to 11 case-based scenarios.
  
  
  RESULTS
  In nine of the scenarios, AUT/GER/SUI neonatologists selected substantially lower PLT transfusion thresholds than US neonatologists (p < 0.0001). Transfusion thresholds were more similar when treating neonatal alloimmune thrombocytopenia and before invasive procedures. The clinical impact of these differences was estimated by extrapolating the AUT/GER/SUI versus the US answers to a cohort of neonates with a birth weight below 1000 g. This suggested that, in AUT/GER/SUI, these neonates would receive 167 PLT transfusions per 1000 infants, compared to 299 PLT transfusions in the United States.
  
  
  CONCLUSIONS
  This first international comparative survey on PLT transfusion practice in neonates reveals substantially higher transfusion thresholds in the United States than in AUT/GER/SUI. Well-designed clinical studies are needed to address the risks and/or benefits of these different approaches.
authors.affiliation: Department of Neonatology and the Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Cremer
authors.forename: Martha
authors.initials: M
authors.lastname: Sola-Visner
authors.forename: Stephanie
authors.initials: S
authors.lastname: Roll
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Josephson
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Yilmaz
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
authors.forename: Christof
authors.initials: C
authors.lastname: Dame
mesh_terms: D000328:Adult; D001317:Austria; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D005858:Germany; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D020407:Internet; D008297:Male; D017713:Platelet Transfusion; D013557:Switzerland; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000628:therapy*; D014481:United States