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Identifying barriers to complying with new restrictive NICU transfusion guidelines

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objectives

Our NICU transfusion stewardship group proposed new, more restrictive guidelines for red blood cell and platelet transfusions. To evaluate our clinician’s support for these, we conducted a series of structured interviews.

Study design

We presented 11 scenarios involving the new guidelines to each of 24 clinicians. After every scenario we asked whether they would abide by the guideline, and if not, why.

Results

For 88% of scenarios, participants said they supported the guideline and would not transfuse. The most common reasons for wanting to transfuse when the guidelines said not to were; 1) the scenario-patient did not meet the guideline but was “close” and 2) the guideline was insufficiently explicit.

Conclusions

Structured interviews like these can identify barriers to complying with transfusion guidelines and can suggest guideline modifications. Future studies will determine the effect of this discovery process on guideline adherence and patient outcomes.

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Data availability

Inquiries regarding data access can be addressed to the corresponding author.

References

  1. Davenport P, Sola-Visner M. Immunologic effects of red blood cell and platelet transfusions in neonates. Curr Opin Hematol. 2022;29:297–305.

  2. Pellegrino C, Papacci P, Beccia F, et al. Differences in cerebral tissue oxygenation in preterm neonates receiving adult or cord blood red blood cell transfusions. JAMA Netw Open. 2023;6:e2341643.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Christensen RD, Bahr TM, Davenport P, Sola-Visner MC, Ohls RK, Ilstrup SJ, et al. Implementing evidence-based restrictive neonatal intensive care unit platelet transfusion guidelines. J Perinatol. 2024. https://doi.org/10.1038/s41372-024-02050-x.

    Article  PubMed  Google Scholar 

  4. Bahr TM, Snow GL, Christensen TR, Davenport P, Henry E, Tweddell SM, et al. Can red blood cell and platelet transfusions have a pathogenic role in bronchopulmonary dysplasia? J Pediatr. 2024;265:113836.

    Article  CAS  PubMed  Google Scholar 

  5. Bahr TM, Ohls RK, Henry E, Davenport P, Ilstrup SJ, Kelley WE, et al. The number of blood transfusions received and the incidence and severity of chronic lung disease among NICU patient born >31 weeks gestation. J Perinatol. 2024. https://doi.org/10.1038/s41372-024-02135-7.

    Article  PubMed  Google Scholar 

  6. Davenport PE, Wood TR, Heagerty PJ, Sola-Visner MC, Juul SE, Patel RM. Platelet transfusion and death or neurodevelopmental impairment in children born extremely preterm. JAMA Netw Open. 2024;7:e2352394.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kirpalani H, Bell EF, Hintz SR, Tan S, Schmidt B, Chaudhary AS, et al. Eunice Kennedy Shriver NICHD Neonatal Research Network. Higher or lower hemoglobin transfusion thresholds for preterm infants. N. Engl J Med. 2020;383:2639–51.l.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Franz AR, Engel C, Bassler D, Rüdiger M, Thome UH, Maier RF, et al. ETTNO Investigators. Effects of liberal vs restrictive transfusion thresholds on survival and neurocognitive outcomes in extremely low-birth-weight Infants: the ETTNO randomized clinical trial. JAMA. 2020;324:560–70.

    Article  PubMed  Google Scholar 

  9. Curley A, Stanworth SJ, Willoughby K, Fustolo-Gunnink SF, Venkatesh V, Hudson C, et al. PlaNeT2 MATISSE Collaborators. Randomized trial of platelet-transfusion thresholds in neonates. N Engl J Med. 2019;380:242–51.

    Article  CAS  PubMed  Google Scholar 

  10. Bahr TM, Christensen TR, Henry E, Astin M, Ilstrup SJ, Ohls RK, et al. Platelet transfusions in a multi-neonatal intensive care unit health care organization before and after publication of the PlaNeT-2 clinical trial. J Pediatr. 2023;257:113388.

    Article  PubMed  Google Scholar 

  11. Scrivens A, Reibel NJ, Heeger L, Stanworth S, Lopriore E, New HV, et al. Neonatal Transfusion Network. Survey of transfusion practices in preterm infants in Europe. Arch Dis Child Fetal Neonatal Ed. 2023;108:360–6.

    Article  PubMed  Google Scholar 

  12. Francis JJ, Tinmouth A, Stanworth SJ, Grimshaw JM, Johnston M, Hyde C, et al. Using theories of behaviour to understand transfusion prescribing in three clinical contexts in two countries: development work for an implementation trial. Implement Sci. 2009;4:70.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ma T, Sun Y, Wang Q, Liu F, Hua K, Wang L, et al. Retrospective cohort study of neonatal blood transfusion in China. BMC Pediatr. 2023;23:621.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Use of blood products for elective surgery in 43 European hospitals. The Sanguis Study Group. Transfus Med. 1994;4:251–68.

  15. Rubin R. It takes an average of 17 years for evidence to change practice-the burgeoning field of implementation science seeks to speed things up. JAMA. 2023;329:1333–6.

    Article  PubMed  Google Scholar 

  16. Chegini A, Jamalian A, Abolhassani MR, Alavi AB. A review of issues and challenges of implementation of patient blood management. Asian J Transfus Sci. 2024;18:115–23.

    Article  PubMed  Google Scholar 

  17. Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022;150:e2022058859.

    Article  PubMed  Google Scholar 

  18. van der Staaij H, van der Bom JG, Caram-Deelder C, Lopriore E, Fijnvandraat K, Fustolo-Gunnink SF, et al. Predicting outcomes in preterm neonates with thrombocytopenia (PROSPEC). ClinicalTrials.gov (NCT 06043050). https://clinicaltrials.gov/study/NCT06043050.

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Author information

Authors and Affiliations

  1. Department of Neonatology, Intermountain Healthcare, Murray, UT, USA

    Sarah M. Tweddell, Timothy M. Bahr & Robert D. Christensen

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

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

  3. Department of Mathematics, University of California at Berkeley, Berkely, CA, USA

    Thomas M. Morelli

  4. Healthcare Delivery Institute, Intermountain Health, Murray, UT, USA

    Ashley Krueger

Authors
  1. Sarah M. Tweddell
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  2. Thomas M. Morelli
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  3. Timothy M. Bahr
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  4. Ashley Krueger
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  5. Robert D. Christensen
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  6. Robin K. Ohls
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Contributions

SMT and TMM; study design, collection and assembly of data and final approval of manuscript. TMB; study design, collection and assembly of data, data analysis and interpretation, manuscript writing, editing, and final approval of manuscript. AK, RDC, and RKO, study design, data analysis, manuscript writing, editing, and final approval of manuscript.

Corresponding author

Correspondence to Timothy M. Bahr.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The Intermountain Health IRB determined this study to be outside the definition of human subject research, that it was exempt from IRB review, and that it did not require written informed consent.

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Tweddell, S.M., Morelli, T.M., Bahr, T.M. et al. Identifying barriers to complying with new restrictive NICU transfusion guidelines. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02225-0

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  • DOI: https://doi.org/10.1038/s41372-025-02225-0

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