Impact of transfusion guidelines on neonatal transfusions

Preterm infants with birth weights (BW) <1250 gm are given multiple blood transfusions either for replacement of blood loss or for correction of symptomatic anemia of prematurity.

To assess the effectiveness of transfusion guidelines in reducing the number of transfusions given to infants with BW <1250 gm.

This cohort study was conducted at the regional teaching medical center with level III obstetric and neonatal services. Preterm infants with BW <1250 gm and gestational age <32 weeks were admitted to the neonatal intensive care unit during a period of 6 months before and after implementation of transfusion guidelines. The final sample size constituted 39 infants before guidelines (BG) and 41 infants after guidelines (AG). The primary outcome measure was the total number and volume of transfusions given per infant in the first 2 weeks of life and before discharge from the nursery.

We observed a significant reduction in the mean number (4.7 to 2.7, p = 0.003) and volume (52 ml to 30 ml, p = 0.0005) of transfusions given per infant in the first 2 weeks of life, as well as a definite trend toward reduction in the total number (10.5 to 8.0, p = 0.08) and volume (156 ml to 119 ml, p = 0.07) of transfusions given before discharge in the BG versus AG, respectively. When all the transfusions given to the 41 infants in the AG group were analyzed for compliance with guidelines, 96% (313 of 328) were observed to be in compliance.

This study shows that transfusion guidelines are effective in decreasing the number of transfusion given to infants with BW <1250 gm. An indirect benefit of guidelines contributing to a reduced number of transfusions may be a heightened awareness to decrease blood losses.