Minimizing blood loss and need for transfusions in newborns

Minimizing blood loss and need for blood transfusions is a priority in the care of preterm and critically ill term newborns that can be facilitated at birth by deferring cord clamping for at least 60 seconds in both preterm and term infants. Also, using umbilical cord blood sampling for initial blood work in preterm infants, whenever feasible, and avoiding routine blood work whenever possible, help to minimize blood loss and transfusion need. In very preterm and very low birth weight infants, a restrictive red cell transfusion strategy stratified by respiratory support and postnatal age is recommended. In late preterm and term neonates who are hemodynamically unstable or in acute severe hypoxemia, blood transfusion strategies should be individualized based on clinical condition. In stable preterm infants without fetal intracranial hemorrhage or major active bleeding, a platelet transfusion threshold of <25 × 10⁹/L should be used.