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  • Quality Improvement Article
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Development and implementation of restrictive platelet transfusion thresholds in a neonatal intensive care unit

Journal of Perinatology (2025)Cite this article

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Abstract

Objective

Thrombocytopenia is a common problem affecting preterm neonates. Recent studies show increased morbidity and mortality with liberal platelet transfusion thresholds. We sought to standardize thrombocytopenia management through a transfusion guideline to reduce excessive transfusions.

Study design

We developed and implemented a guideline using PDSA cycles for infants with birth weights <1000 grams. Platelet transfusions were classified as indicated or non-indicated per the guideline. Severe (grade 3 or 4) intraventricular hemorrhage and pulmonary hemorrhage rates were balancing measures.

Results

We analyzed 101 infants pre-guideline and 96 infants post-guideline. The mean monthly non-indicated transfusions significantly decreased from 13.0 to 2.0, respectively (p-value < 0.01). Incidence of severe grade IVH and pulmonary hemorrhage remained stable.

Conclusion

Rapid implementation of an evidence-based, restrictive platelet transfusion guideline significantly reduced non-indicated platelet transfusions without a concomitant increase in major bleeding events.

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Fig. 1
Fig. 2: Finalized platelet transfusion guidelines flowchart. *Includes ELBWs; excludes ECMO patients.
Fig. 3: Control “p” chart of non-indicated transfusions.
Fig. 4: Pareto chart reveal the vital few and trivial few causes of non-compliance with the established guideline through the 80/20 rule.
Fig. 5: Balancing measures for major bleeding events.

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Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, MO, USA

    Natasha Lalos, Alexa Brumfiel, Luke T. Viehl, Gillian C. Pet & Alexandra Lahart

Authors
  1. Natasha Lalos
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  2. Alexa Brumfiel
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  3. Luke T. Viehl
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  4. Gillian C. Pet
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  5. Alexandra Lahart
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Contributions

NL, GP and AL all contributed to study design. NL and AB contributed to collection and assembly of data. NL completed analysis and interpretation of data. LV contributed to verification of quality improvement metrics. NL, GP, LV and AL contributed to manuscript preparation, writing, editing, and final approval.

Corresponding author

Correspondence to Natasha Lalos.

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The authors declare no competing interests.

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Lalos, N., Brumfiel, A., Viehl, L.T. et al. Development and implementation of restrictive platelet transfusion thresholds in a neonatal intensive care unit. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02302-4

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  • DOI: https://doi.org/10.1038/s41372-025-02302-4

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