Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change

Objective: To evaluate red blood cell (RBC) transfusion practices in preterm neonates before and after protocol change.

Methods: All preterm neonates (<32 weeks of gestation) admitted between 2008 and 2017 at our neonatal intensive care unit were included in this retrospective study. Since 2014, a more restrictive transfusion guideline was implemented in our unit. We compared transfusion practices before and after this guideline change. Primary outcome was the number of transfusions per neonate and the percentage of neonates receiving a blood transfusion. Secondary outcomes were neonatal morbidities and mortality during admission.

Results: The percentage of preterm neonates requiring a blood transfusion was 37·5% (405/1079) before and 32·7% (165/505) after the protocol change (P = 0·040). The mean number of transfusions given to each transfused neonate decreased from 2·93 (standard deviation (SD) ± 2·26) to 2·20 (SD ±1·29) (P = 0·007). We observed no association between changes in transfusion practices and neonatal outcome.

Conclusion: The use of a more restrictive transfusion guideline leads to a reduction in red blood cell transfusions in preterm neonates, without evidence of an increase in mortality or short-term morbidity.