Our suggested thresholds for RBC transfusion in neonates

Clinical instability is defined by the presence of at least one of the following:
Invasive mechanical ventilation Circulatory failure requiring inotropic/vasopressor support CPAP or other non-invasive positive pressure ventilation support with fraction of inspired oxygen >0.4 Acute sepsis or necrotizing enterocolitis with hemodynamic instability requiring pressor support >6 documented apneas requiring moderate intervention per 24 hours Undergoing major surgery (within or up to 48 hours after surgery)
Postnatal age	Gestational age	Hemoglobin (hematocrit) thresholds for transfusion
Postnatal age	Gestational age	Neonates with clinical instability	Neonates without clinical instability
0-7 days	Any	11 g/dL (32%)	10 g/dL (29%)
8-14 days	<35 weeks	10 g/dL (29%)	8 g/dL (24%)
8-14 days	≥35 weeks	7 g/dL (21%)*	7 g/dL (21%)*
≥15 days	<35 weeks	8 g/dL (24%)	7 g/dL (21%)^¶
≥15 days	≥35 weeks	7 g/dL (21%)*	7 g/dL (21%)*

This table summarizes our suggested hemoglobin and hematocrit thresholds for considering a RBC transfusion in neonates based upon postnatal age and clinical status. These thresholds are appropriate for term and preterm neonates cared for in the NICU. These thresholds do not apply to neonates with cyanotic congenital heart disease, severe alloimmune hemolytic disease, acute severe or ongoing blood loss, severe PPHN, or those on ECMO. For additional details, refer to separate UpToDate content on RBC transfusions in neonates.

CPAP: continuous positive airway pressure; RBC: red blood cell; NICU: neonatal intensive care unit; ECMO: extracorporeal membrane oxygenation; AOP: anemia of prematurity; PPHN: persistent pulmonary hypertension of the newborn; Hgb: hemoglobin; HCT: hematocrit; SGA: small for gestational age.

* This threshold is appropriate for most neonates in these categories, provided they are not SGA (in which case the preterm thresholds should be used). The Hgb <7 g/dL (HCT <21%) threshold applies to clinically stable neonates and to critically ill neonates who are hemodynamically stabilized (ie, not hypotensive and not requiring escalating inotropic/vasopressor support). A higher threshold may be warranted in neonates with severe or progressive shock and/or severe hypoxemia. In addition, separate thresholds are used for neonates with any of the conditions listed above in the legend.

¶ For preterm neonates with AOP who otherwise appear well and are asymptomatic but who continue to have significant anemia (ie, Hgb <7 g/dL or HCT <21%) at four to six weeks after birth, measuring the reticulocyte count can help guide decisions regarding RBC transfusion. If the absolute reticulocyte is ≥100,000/microL (≥2%), RBC transfusion may not be necessary.

Graphic 140490 Version 3.0

خرید پکیج

Our suggested thresholds for RBC transfusion in neonates