Restrictive guideline reduces platelet count thresholds for transfusions in very low birth weight preterm infants


Amélia Miyashiro Nunes dos Santos, Rua Diogo de Faria 764. CEP: 04037-002. SP, Brazil


Background and Objectives  Platelet transfusions are performed almost entirely according to expert experience. This study assessed the effectiveness of a restrictive guideline to reduce platelet transfusions in preterm infants.

Methods  A retrospective cohort of preterm infants with a birth weight of <1500 g had been born in 2 periods. In Period 1, a transfusion was indicated for a platelet count of <50 000/ml in clinically stable neonates or <100 000/ml in bleeding or clinically unstable infants. In Period 2, the indications were restricted to <25 000/ml in clinically stable neonates, or <50 000/ml in newborns who were either on mechanical ventilation, subject to imminent invasive procedures, within 72 h following a seizure, or extremely premature and <7 days old. A count of <100 000/ml was indicated for bleeding or major surgery.

Results  Periods 1 and 2 comprised 121 and 134 neonates, respectively. The rates of ventricular haemorrhage and intrahospital death were similar in both periods. The percentage of transfused infants, the odds of receiving a platelet transfusion, the mean platelet count before transfusion and the percentage of transfusions with a platelet count >50,000/ml were greater in Period 1. Among thrombocytopenic neonates, the percentage of transfused neonates and the number of transfusions were similar in both groups.

Conclusion  The restrictive guideline for platelet transfusions reduced the platelet count thresholds for neonatal transfusions without increasing the rate of ventricular haemorrhage.