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Implementing evidence-based restrictive neonatal intensive care unit platelet transfusion guidelines

Journal of Perinatology volume 44, pages 1394–1401 (2024)Cite this article

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Abstract

Platelet transfusions are life-saving treatments for specific populations of neonates. However, recent evidence indicates that liberal prophylactic platelet transfusion practices cause harm to premature neonates. New efforts to better balance benefits and risks are leading to the adoption of more restrictive platelet transfusion guidelines in neonatal intensive care units (NICU). Although restrictive guidelines have the potential to improve outcomes, implementation barriers exist. We postulate that as neonatologists become more familiar with the data on the harm of liberal platelet transfusions, enthusiasm for restrictive guidelines will increase and barriers to implementation will decrease. Thus, we focused this educational review on; (1) the adverse effects of platelet transfusions to neonates, (2) awareness of platelet transfusion “refractoriness” in thrombocytopenic neonates and its association with poor outcomes, and (3) the impetus to find alternatives to transfusing platelets from adult donors to NICU patients.

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Fig. 1: Mortality rate of 1600 NICU patients with a platelet count <150,000/µL, according to the number of platelet transfusions received [9].
Fig. 2: Mortality rate of 273 NICU patients with a platelet count <50,000/µL, according to the number of platelet transfusions received [10].
Fig. 3: Schematic representation of umbilical cord collection to produce a platelet transfusion product.

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Acknowledgements

We thank Jeni Walker, Division of Neonatology, University of Utah, for the illustration.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Robert D. Christensen, Timothy M. Bahr & Robin K. Ohls

  2. Women and Newborns Research, Intermountain Health, Murray, UT, USA

    Robert D. Christensen & Timothy M. Bahr

  3. Division of Newborn Medicine Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Patricia Davenport & Martha C. Sola-Visner

  4. Transfusion Medicine, Department of Pathology, Intermountain Health, Murray, UT, USA

    Sarah J. Ilstrup

  5. American National Red Cross, Salt Lake City, UT, USA

    Walter E. Kelley

  6. Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA

    Walter E. Kelley

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  1. Robert D. Christensen
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  4. Martha C. Sola-Visner
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RDC, TMB, PD, MCS-V, RKO, SJI and WEK; conception and design, assembly of data, manuscript writing, and final approval of the manuscript.

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Correspondence to Robert D. Christensen.

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Christensen, R.D., Bahr, T.M., Davenport, P. et al. Implementing evidence-based restrictive neonatal intensive care unit platelet transfusion guidelines. J Perinatol 44, 1394–1401 (2024). https://doi.org/10.1038/s41372-024-02050-x

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