Consensus Blood Product Transfusion Guidelines for a Large Neonatal Care Network

product transfusions, but clinical practices vary widely. Many very low birth weight (VLBW) infants receive packed red blood cell (RBC) or platelet transfusions during their initial NICU stay, with incidence inversely proportional to gestational age at birth 1,2. Many critically ill infants are also transfused with plasma or cryoprecipitate to promote coagulation 3,4. These blood product transfusions are most often prophylactic, with clinical decisions made in response to numerical blood count values, as opposed to therapeutic transfusions in the context of active bleeding.Emerging evidence has shown that some transfusion practices are harmful for certain NICU patients, such as platelet transfusions in preterm infants 5,6. More broadly, transfusion reactions can occur with virtually all blood products 7 and these reactions are likely under-diagnosed, under-estimated, and under-reported in pediatric patients 3. Our intention was to establish optimal transfusion guidelines for our division and neonatal network, including 19 hospitals, based on a review of currently available literature.