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Temporal Trends in Red Blood Cell and Platelet Transfusion Thresholds for Extremely Low Birth Weight Infants.

Ravi M Patel1, Jeanne E Hendrickson2, Rebecca Birch3

  • 1Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.

The Journal of Pediatrics
|August 31, 2025
PubMed
Summary

Hematologic thresholds for extremely low birth weight (ELBW) infants show declining red blood cell (RBC) transfusion levels but stable platelet transfusion levels. This suggests varied adoption of new transfusion evidence in clinical practice.

Keywords:
bloodinfantplateletpretermred blood celltransfusion

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Area of Science:

  • Neonatal Medicine
  • Pediatric Hematology
  • Clinical Transfusion Practices

Background:

  • Evidence from randomized trials has informed new transfusion guidelines for extremely low birth weight (ELBW) infants.
  • The impact of this evidence on clinical practice regarding transfusion thresholds remains to be fully elucidated.
  • Understanding temporal trends in transfusion practices is crucial for optimizing care in vulnerable neonatal populations.

Purpose of the Study:

  • To assess changes in hematologic thresholds for red blood cell (RBC) and platelet transfusions in ELBW infants.
  • To determine if these thresholds evolved over time after the publication of key randomized trial evidence.
  • To investigate if trends in transfusion thresholds varied by postnatal age.

Main Methods:

  • Analysis of data from the REDS-IV-P study (April 2019-December 2023) involving 981 ELBW infants.
  • Comparison of pre-transfusion hemoglobin and platelet counts within 24 hours of transfusion, analyzed by year.
  • Linear mixed models used to identify trends over time and interactions with postnatal weeks.

Main Results:

  • Pre-transfusion hemoglobin thresholds significantly declined over the study period (P<0.0001), with the most pronounced decrease observed from the third postnatal week onwards.
  • No significant change in pre-transfusion platelet count thresholds was detected over time (P=0.24).
  • While not statistically significant, pre-transfusion platelet counts were lower after the first postnatal week (P<0.001).

Conclusions:

  • Observed declines in pre-transfusion hemoglobin thresholds but not platelet thresholds in US centers from 2019-2023.
  • Findings suggest differential implementation of evidence from recent RBC and platelet transfusion trials into clinical practice for ELBW infants.
  • Further research may be needed to understand the reasons for this differential adoption and its clinical implications.