Data Suggest Wide Variability in Neonatal Transfusion Thresholds
April 13, 2021
There is wide variability in pretransfusion hemoglobin, platelet count and international normalized ratio (INR) values for neonatal transfusions, according to findings from a retrospective cohort study published recently in
The Journal of Pediatrics. Investigators in this retrospective cohort study evaluated data from 60,243 neonates transfused at hospitals that participated in the National Heart, Lung and Blood Institute’s
Recipient Epidemiology and Donor Evaluation Study-III (REDS-III).
The incidence of any transfusion differed by gestational age, with 80% of neonates transfused at less than 27 weeks’ gestation (329 infants) and 0.5% transfused at 37 weeks’ gestation or greater (53,919 infants). For the entire cohort, the median pretransfusion hemoglobin was 11.2 g/dL. Median pretransfusion hemoglobin ranged from 10.5 g/dL for extremely preterm infants (less than 27 weeks’ gestation) to 13.0 g/dL for term infants. The median pretransfusion platelet count was 71 for the entire cohort and was greater than 45 for all gestational age groups examined. The median pretransfusion INR was 1.7 for the entire cohort.
According to investigators, the findings suggest that a large proportion of neonatal transfusions in the U.S. are administered at thresholds higher than supported by the best available evidence. They believe the findings highlight an opportunity for improved patient blood management.