Transfusion Practices in 12 Neonatal Networks: Are We Closer to Adopting a Restrictive Transfusion Approach?

Area of Science:

• Neonatal Medicine
• Pediatric Hematology
• Clinical Practice Guidelines

Background:

• Emerging evidence supports a restrictive approach to blood transfusions for preterm infants.
• This study investigates current transfusion practices in very premature neonates.

Purpose of the Study:

• To survey blood transfusion practices in preterm neonates (<29 weeks' gestation).
• To assess practices across 12 international neonatal networks (iNeo).

Main Methods:

• An online survey was distributed to 608 neonatal intensive care units (NICUs) globally in 2023.
• Practices were surveyed for four distinct clinical scenarios in preterm infants.
• Scenarios included varying levels of respiratory support and postnatal age.

Main Results:

• 382 NICUs (63%) responded, revealing significant variations in transfusion practices.
• A restrictive approach (hematocrit ≤35% or ≤30%) was common for ventilated infants.
• For stable infants, thresholds were often hematocrit ≤30% (noninvasive support) or ≤25% (no support).

Conclusions:

• Substantial variation exists in blood transfusion practices between countries and within networks.
• Over two-thirds of NICUs have adopted a restrictive transfusion approach.
• Further research is required to align practices with intentions and evaluate their impact on outcomes.