Platelet transfusion practices in neonatology: A single-center observational study

Abstract

Aims: Platelet transfusions are common in the neonatal intensive care unit (NICU), yet practices vary substantially. This study aims to determine platelet transfusion incidence, determinants, and justifications in neonatology. Methods: Single-center prospective cohort study, including all patients consecutively admitted to the CHU Sainte-Justine Hospital NICU over a 5-month period in 2013. Data were collected by chart review and transfusion justifications were assessed using a questionnaire. Results: A total of 401 participants were included. Mean birth weight (BW) was 2.34±1.01 kg and gestational age (GA) was 34.4±4.5 weeks. Thirty-seven neonates (9.2%) received at least one platelet transfusion. Platelet-transfused neonates were mostly extremely preterm (40.5%) or term (24.3%). The median pre-platelet transfusion count was 57 × 109/L (9–285 × 109/L). Compared to non-transfused patients, those who received at least one platelet transfusion had a significantly lower BW and GA, higher CRIB-II and SNAPPE-II scores (all p and#60;0.001) and were more frequently admitted for respiratory disease (p and#60;0.001), hypoxic-ischemic encephalopathy (p=0.009), and hemolytic disease of the newborn (p and#60;0.001). Gestational age and#60;28 weeks (pand#60;0.001), mechanical ventilation requirements (p=0.008), and platelet nadir ≤150 × 109/L (pand#60;0.001) upon admission were independently associated with a higher risk of platelet transfusion in this cohort. Most frequent justifications for ordering a first platelet transfusion were low platelet counts (86.5%), underlying disease (78.4%) and illness severity (37.8%). Conclusion: Pre-transfusion platelet counts in neonates varied widely and were higher than the thresholds proposed in the literature. Several factors other than platelet count predicted risk of platelet transfusion in this cohort.