Adherence to a restrictive platelet transfusion guideline in a neonatal surgical population

In 2019, the PlaNeT-2 trial reported an increased risk of death and/or major bleeding among neonates transfused with platelets at liberal compared to restrictive thresholds. However, especially in the perioperative setting, clinicians often administer platelet transfusions to neonates at higher platelet count thresholds in hopes of reducing the risk of bleeding. In this study, we investigated if platelet transfusion practices changed in neonates with primary surgical diagnoses after the implementation of a restrictive platelet transfusion guideline in January of 2019.

In this retrospective study, platelet transfusions administered to infants who underwent at least one operation between January 2017 and December 2020 were classified as either indicated or non-indicated using the new guideline. Patient characteristics, diagnoses, platelet counts, and transfusion indications were collected.

58 surgical patients received 221 platelet transfusions. The number of indicated platelet transfusions did not change between periods, but the number of non-indicated transfusions significantly decreased (73 pre-vs 20 post-guideline, p < 0.0001). The median platelet count prompting transfusion decreased from 31 × 10⁹/L to 26 × 10⁹/L, p = 0.0074. There were no differences in the number of platelet transfusions administered for active bleeding in either period.

Platelet transfusions pose risks in neonates and data from a large, randomized trial supports the use of restrictive guidelines to minimize harm. In this study, we found that implementation of a restrictive platelet transfusion guideline decreased the number of non-indicated platelet transfusions in neonates with primary surgical diagnoses without an increase in transfusions given in the setting of active bleeding.