Transfusions in the Preterm Infant

Abstract

Preterm infants in the neonatal intensive care unit receive a greater number of red cell transfusions than any other hospitalized patient group. During the first weeks after birth, when blood draws are frequent and phlebotomy losses are high, approximately 50% of extremely low birthweight (ELBW) infants receive their first transfusion. (1) By the end of hospitalization, approximately 85% of ELBW infants have received at least one transfusion. (2)(3)(4) Although the numbers of transfusions administered to preterm infants remains significant, they have decreased over the last 20 years, primarily due to the institution of restrictive transfusion guidelines in conjunction with the study of erythropoietin administration to preterm infants. (5)(6) This article reviews the need for administering red cell transfusions, summarizes studies evaluating the efficacy of restrictive transfusion guidelines, and provides strategies to decrease red cell transfusions in neonates, including instituting neonatal transfusion guidelines.