Transfusion practices in 12 Neonatal Networks - Are we closer to adopting a restrictive transfusion approach?

Background: Recent evidence suggests a restrictive approach towards blood transfusions for management of preterm infants.

Objective: To survey blood transfusion practises in preterm neonates <29 weeks' gestation among 12 population-based neonatal-networks participating in the International Network for Evaluating Outcomes in Neonates (iNeo).

Methods: An online survey based on 2023 practices was sent to 608 neonatal intensive care units (NICU's): Australia/New-Zealand (n= 30), Brazil (20), Canada (32), Finland (5), France (70), Israel (26), Japan (292), Poland (56), Spain (55), Sweden (9), Switzerland (9), and Tuscany, Italy (4). Transfusion thresholds in four different scenarios were surveyed: (a) infants invasively ventilated within first 7 postnatal days, (b) infants invasively ventilated after 7 days, (c) stable infants on non-invasive respiratory support, and (d) stable infants requiring no respiratory support.

Results: A total of 382 NICU's (63%) responded. Transfusion practices varied within networks and between countries. For invasively ventilated infants, the transfusion threshold during first 7 days after birth was a hematocrit ≤35% in 79% of NICUs, and at an age >8 days was a hematocrit ≤30% in 68% of NICU's. For stable infants on non-invasive ventilation, the transfusion threshold was a hematocrit ≤30% in 80%, and in those without respiratory support, a hematocrit of ≤25% in 68% of NICU's.

Conclusions: Variations exist in blood transfusion practises between countries and within networks. A restrictive transfusion approach based on recent recommendations has been adopted by more than two-thirds of NICU's. Additional research is needed to evaluate whether practices align with intentions and how they impact outcomes.