title: Restrictive guideline reduces platelet count thresholds for transfusions in very low birth weight preterm infants.
abstract: OBJECTIVE
  Platelet transfusions are performed almost entirely according to expert experience. This study assessed the effectiveness of a restrictive guideline to reduce platelet transfusions in preterm infants.
  
  
  METHODS
  A retrospective cohort of preterm infants with a birth weight of <1500 g had been born in 2 periods. In Period 1, a transfusion was indicated for a platelet count of <50,000/ml in clinically stable neonates or <100,000/ml in bleeding or clinically unstable infants. In Period 2, the indications were restricted to <25,000/ml in clinically stable neonates, or <50,000/ml in newborns who were either on mechanical ventilation, subject to imminent invasive procedures, within 72 h following a seizure, or extremely premature and <7 days old. A count of <100,000/ml was indicated for bleeding or major surgery.
  
  
  RESULTS
  Periods 1 and 2 comprised 121 and 134 neonates, respectively. The rates of ventricular haemorrhage and intrahospital death were similar in both periods. The percentage of transfused infants, the odds of receiving a platelet transfusion, the mean platelet count before transfusion and the percentage of transfusions with a platelet count >50,000/ml were greater in Period 1. Among thrombocytopenic neonates, the percentage of transfused neonates and the number of transfusions were similar in both groups.
  
  
  CONCLUSIONS
  The restrictive guideline for platelet transfusions reduced the platelet count thresholds for neonatal transfusions without increasing the rate of ventricular haemorrhage.
authors.affiliation: Neonatal Division of Medicine, Department of Pediatrics, Federal University of São Paulo, SP, Brazil.
authors.forename: J P G
authors.initials: JP
authors.lastname: Borges
authors.forename: A M N
authors.initials: AM
authors.lastname: dos Santos
authors.forename: D H F
authors.initials: DH
authors.lastname: da Cunha
authors.forename: A F M A
authors.initials: AF
authors.lastname: Mimica
authors.forename: R
authors.initials: R
authors.lastname: Guinsburg
authors.forename: B I
authors.initials: BI
authors.lastname: Kopelman
mesh_terms: D001792:Blood Platelets; D001835:Body Weight; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal / Q000458:organization & administration; D008297:Male; D010865:Pilot Projects; D010976:Platelet Count / Q000592:standards*; D017713:Platelet Transfusion / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012640:Seizures / Q000628:therapy; D013997:Time Factors