Document Detail

International survey of transfusion practices for extremely premature infants.
MedLine Citation:
PMID:  22818544     Owner:  NLM     Status:  MEDLINE    
Our objective was to survey neonatologists regarding international practice of red cell transfusion thresholds for premature infants with <1000-g birth weight and/or <28-week gestation. An invitation to fill out an 11-question web-based survey was distributed to neonatologists through their professional societies in 22 countries. Physicians were asked about which specific factors, in addition to hemoglobin levels, influenced their decisions about transfusing premature infants. These factors included gestational age, postnatal age, oxygen need, respiratory support, reticulocyte count, and inotropic support. Physicians were presented with 5 scenarios and asked to identify hemoglobin cutoff values for transfusing infants with <1000-g birth weight and/or <28-week gestation. One thousand eighteen neonatologists responded: the majority were from the United States (67.5%), followed by Germany (10.7%), Japan (8.0%), the United Kingdom (4.9%), Spain (3.9%), Italy (2.6%), Colombia (0.6%), Argentina (0.4%), Canada (0.4%), Belgium (0.1%), and the Netherlands (0.1%). Half of the respondents (51.1%) reported having a written policy with specific red cell transfusion guidelines in their unit. Factors considered "very important" regarding the need to administer blood transfusions included degree of oxygen requirement (44.7%) and need for respiratory support (44.1%). Erythropoietin was routinely used to treat anemia by 26.0% of respondents. Delayed cord clamping or cord milking was practiced by 29.1% of respondents. The main finding was of a wide variation in the hemoglobin values used to transfuse infants, regardless of postnatal age. Step-wise increments in the median hemoglobin cutoffs directly paralleled an increase in the need for levels of respiratory support. In the first week of life, there was a wider range in the distribution of hemoglobin transfusion thresholds for infants requiring no respiratory support and full mechanical ventilation compared with the thresholds used in the second, third, and fourth weeks of life. An international survey using hypothetical scenarios shows that red blood cell transfusion practices vary widely among practicing neonatologists in participating countries.
Ursula Guillén; James J Cummings; Edward F Bell; Shigerharu Hosono; Axel R Frantz; Rolf F Maier; Robin K Whyte; Elaine Boyle; Max Vento; John A Widness; Haresh Kirpalani
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in perinatology     Volume:  36     ISSN:  1558-075X     ISO Abbreviation:  Semin. Perinatol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-23     Completed Date:  2012-12-07     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  7801132     Medline TA:  Semin Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  244-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Section of Neonatology, Christiana Care Health System, Newark, DE, USA.
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MeSH Terms
Anemia, Neonatal / therapy
Erythrocyte Indices
Erythrocyte Transfusion / statistics & numerical data*
Erythropoietin / therapeutic use
Gestational Age
Great Britain
Hematinics / therapeutic use
Infant, Extremely Low Birth Weight
Infant, Extremely Premature
Infant, Newborn
Neonatology / statistics & numerical data*
Physician's Practice Patterns / statistics & numerical data*
United States
Grant Support
Reg. No./Substance:
0/Hematinics; 0/Hemoglobins; 11096-26-7/Erythropoietin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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