Transfusion Practices in 12 Neonatal Networks: Are We Closer to Adopting a Restrictive Transfusion Approach?

Gil Klinger; Kjell Helenius; Maximo Vento; Satoshi Kusuda; Mikael Norman; Renato Soibelman Procianoy; Neha Goswami; Valerie Biran; Dirk Bassler; Brian Reichman; Aleksandra Skubisz; Malcolm Battin; Liisa Lehtonen; Kei Lui; Annalisa Mori; Marc Beltempo; Mark Adams; Laura San Feliciano; Tetsuya Isayama; Prakesh S Shah; iNeo Investigators

doi:10.1159/000546612

Transfusion Practices in 12 Neonatal Networks: Are We Closer to Adopting a Restrictive Transfusion Approach?

Neonatology. 2025;122(5):561-569. doi: 10.1159/000546612. Epub 2025 May 28.

Authors

Gil Klinger^{1

2}, Kjell Helenius³, Maximo Vento⁴, Satoshi Kusuda⁵, Mikael Norman⁶, Renato Soibelman Procianoy⁷, Neha Goswami⁸, Valerie Biran⁹, Dirk Bassler¹⁰, Brian Reichman^{2

11}, Aleksandra Skubisz¹², Malcolm Battin¹³, Liisa Lehtonen³, Kei Lui¹⁴, Annalisa Mori¹⁵, Marc Beltempo¹⁶, Mark Adams¹⁰, Laura San Feliciano¹⁷, Tetsuya Isayama¹⁸, Prakesh S Shah⁸; iNeo Investigators

Affiliations

¹ Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
² Tel Aviv University, Tel Aviv, Israel.
³ Department of Pediatrics and Adolescent Medicine, Turku University Hospital, and Department of Clinical Medicine, University of Turku, Turku, Finland.
⁴ Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain.
⁵ Neonatal Research Network of Japan, Kyorin University, Tokyo, Japan.
⁶ Department of Neonatal Medicine, Karolinska University Hospital and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
⁷ Newborn Section, Universidade Federal do Rio Grande do Sul (UFRGS) and Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
⁸ Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
⁹ Service de Pédiatrie et Réanimation Néonatales, Hôpital Universitaire Robert-Debré, Université de Paris-Cité, Paris, France.
¹⁰ Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
¹¹ Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel.
¹² Department of Neonatology and NICU, Clinical Provincial Hospital No 2, University of Rzeszów, Rzeszow, Poland.
¹³ Newborn Services, Auckland City Hospital, Auckland, New Zealand.
¹⁴ National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Randwick, New South Wales, Australia.
¹⁵ Neonatal Intensive Care Unit, University Hospital of Siena, Siena, Italy.
¹⁶ Department of Pediatrics, McGill University, Montreal, Québec, Canada.
¹⁷ Unidad de Neonatología, Hospital Universitario de Salamanca, Salamanca, Spain.
¹⁸ Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.

Abstract

<p>Introduction: Recent evidence suggests a restrictive approach toward blood transfusions for management of preterm infants. Objective was 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 (NICUs): Australia/New Zealand (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 4 different scenarios were surveyed: (a) infants invasively ventilated within first 7 postnatal days, (b) infants invasively ventilated after 7 days, (c) stable infants on noninvasive respiratory support, and (d) stable infants requiring no respiratory support.

Results: A total of 382 NICUs (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 <underline>≤</underline>35% in 79% of NICUs, and at an age ≥8 days, the transfusion threshold was a hematocrit <underline>≤</underline>30% in 68% of NICUs. For stable infants on noninvasive ventilation, the transfusion threshold was a hematocrit <underline>≤</underline>30% in 80%, and in those without respiratory support, the transfusion threshold was a hematocrit of <underline>≤</underline>25% in 68% of NICUs.

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 NICUs. Additional research is needed to evaluate whether practices align with intentions and how they impact outcomes. </p>.

Keywords: Blood transfusions; Extremely preterm infants; Transfusion policy.

Publication types

Multicenter Study

MeSH terms

Blood Transfusion* / methods
Blood Transfusion* / standards
Blood Transfusion* / statistics & numerical data
Europe
Gestational Age
Health Care Surveys
Hematocrit
Humans
Infant, Extremely Premature
Infant, Newborn
Infant, Premature*
Intensive Care Units, Neonatal*
Practice Patterns, Physicians'*
Respiration, Artificial
Surveys and Questionnaires