title: How we decide when a neonate needs a transfusion.
abstract: The decision to transfuse a neonate can be approached by addressing a series of questions that cover the cause of anaemia, alternatives to transfusion, the need for transfusion and the risks. Recent clinical trials of red cell transfusions have started to inform evidence-based transfusion practice, but have raised uncertainties about neurological outcomes when policies advocating use of fewer red cell transfusions at lower haemoglobin concentration (Hb) thresholds were tested. Red cell transfusions should be considered when the Hb <120 g/l for premature neonates requiring mechanical ventilation support, with lower thresholds applying for oxygen-dependent neonates not requiring ventilation or for late anaemia (Hb <70-100 g/l, depending on gestational and post-natal age). There is no recent high quality evidence to inform thresholds for prophylactic platelet transfusions in stable non-bleeding premature neonates with platelet count levels of 50 × 10(9) /l, although common practice has become more restrictive, using lower safe thresholds for platelet transfusion between 20 and 30 × 10(9) /l. A more appropriate transfusion strategy for fresh frozen plasma (FFP) in neonates is one that emphasizes the therapeutic use of FFP in the face of bleeding, rather than prophylactic use in stable non-bleeding neonates who often have mild to moderate apparent abnormalities of standard coagulation tests, after allowing for appropriate reference ranges.
authors.affiliation: Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Vidheya
authors.initials: V
authors.lastname: Venkatesh
authors.forename: Rizwan
authors.initials: R
authors.lastname: Khan
authors.forename: Anna
authors.initials: A
authors.lastname: Curley
authors.forename: Helen
authors.initials: H
authors.lastname: New
authors.forename: Simon
authors.initials: S
authors.lastname: Stanworth
mesh_terms: D000751:Anemia, Neonatal / Q000209:etiology* / Q000628:therapy*; D001788:Blood Grouping and Crossmatching; D003250:Constriction; D003657:Decision Making; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000592:standards; D004921:Erythropoietin / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D017713:Platelet Transfusion / Q000379:methods; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D014470:Umbilical Cord
chemical_list: D004921:Erythropoietin