Neonates are defined as babies up to 28 days after birth. Most extremely preterm babies (less than 28 weeks) require at least one red cell transfusion; this is partly due to the amount of blood removed with blood samples compared to the baby's total blood volume (iatrogenic anemia) and partly due to

anemia of prematurity Anemia of prematurity (AOP) refers to a form of anemia affecting preterm infants with decreased hematocrit. AOP is a normochromic, normocytic hypoproliferative anemia. The primary mechanism of AOP is a decrease in erythropoietin (EPO), a red blood ...

. Most transfusions are given as small volume top-up transfusions to increase the baby's

hemoglobin Hemoglobin (haemoglobin BrE) (from the Greek word αἷμα, ''haîma'' 'blood' + Latin ''globus'' 'ball, sphere' + ''-in'') (), abbreviated Hb or Hgb, is the iron-containing oxygen-transport metalloprotein present in red blood cells (erythrocyte ...

above a certain pre-defined level, or because the baby is unwell due to the

anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, ...

. Possible side-effects of anemia in babies can be poor growth,

lethargy Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overwor ...

and episodes of

apnea Apnea, BrE: apnoea, is the temporal cessation of breathing. During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the airways are (patency), there may ...

. Exchange blood transfusion is used to treat a rapidly rising

bilirubin Bilirubin (BR) (Latin for "red bile") is a red-orange compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. This catabolism is a necessary process in the body's clearance of waste products that arise from the ...

that does not respond to treatment with

phototherapy Light therapy, also called phototherapy or bright light therapy is intentional daily exposure to direct sunlight or similar-intensity artificial light in order to treat medical disorders, especially seasonal affective disorder (SAD) and circadi ...

intravenous immunoglobulin Immunoglobulin therapy is the use of a mixture of antibodies (normal human immunoglobulin or NHIG) to treat several health conditions. These conditions include primary immunodeficiency, immune thrombocytopenic purpura, chronic inflammatory d ...

. This is usually due to

hemolytic disease of the newborn Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis foetalis, is an alloimmune condition that develops in a fetus at or around birth, when the IgG molecules (one of the fiv ...

, but may also be due to other causes, e.g.,

G6PD deficiency Glucose-6-phosphate dehydrogenase deficiency (G6PDD), which is the most common enzyme deficiency worldwide, is an inborn error of metabolism that predisposes to red blood cell breakdown. Most of the time, those who are affected have no symptoms. ...

When to transfuse

Below are suggested transfusion thresholds for very preterm neonates (less than 32 weeks gestation) by the British Society of Haematology. These are based on systematic reviews of transfusion in very preterm babies. There is no evidence for red cell transfusion thresholds in preterm neonates between 32 and 37 weeks gestation, and the British Society of Haematology suggests using the same thresholds as very preterm neonates that require no respiratory support.

What to transfuse

A small volume transfusion is usually 10 to 20 ml/kg administered at a rate of 5 ml/kg/hour. A large volume transfusion is the estimated entire blood volume of the baby (80 ml/kg) and is usually given during cardiac surgery. A red cell exchange transfusion is usually given to treat severe

hyperbilirubinemia Bilirubin (BR) (Latin for "red bile") is a red-orange compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. This catabolism is a necessary process in the body's clearance of waste products that arise from the ...

or anemia in babies with

. It removes neonatal red cells coated with maternal antibody and reduces the level of bilirubin. A ‘double volume exchange’ (160–200 ml/kg) removes around 90% of neonatal red cells and 50% of bilirubin. The specification of the blood product differs depending on whether it is to be used for a small volume, large volume or exchange transfusion. There does not appear to be any benefit to giving fresher red blood cells (less than a week from donation) compared to standard red cells (usually two weeks after donation) for small volume transfusions.

Safety considerations

The

Serious Hazards of Transfusion Serious Hazards of Transfusion (SHOT) is the United Kingdom's haemovigilance scheme. It collects and analyses anonymized information on adverse events and blood transfusion reactions. When SHOT has identified risks related to transfusion, it produ ...

(SHOT) hemovigilance reporting scheme has shown that there are a disproportionate number of transfusion errors in babies. There are multiple reasons why this occurs. It can be due to confusion between samples from the mother and the baby, birth of more than one baby, babies who don’t yet have a first name, or that no ID information has been attached to the baby (e.g. wristband).{{Cite web, url=http://hospital.blood.co.uk/audits/national-comparative-audit/paediatric-and-neonatal-audits/, title=Paediatric and neonatal audits {{! NHSBT Hospitals and Science, website=hospital.blood.co.uk, access-date=2018-05-18 Paedipacks are multiple aliquots made from one adult blood donation. By using paedipacks, the baby is exposed to blood from fewer blood donors. ABO blood grouping and screening for antibodies in neonates differs from blood grouping in adults and older children. Any antibodies detected are the mother's antibodies rather than the baby's. Therefore, any donor blood given to the baby must be ABO and D compatible with both mother and baby; and antigen-negative for any clinically significant maternal antibodies.

Necrotising enterocolitis Necrotizing enterocolitis (NEC) is a devastating intestinal disease that affects premature or very low birth weight infants.Gephart S.M., Quinn M. A call to action to fight for equity and end necrotizing enterocolitis disparities. ''Adv. Neonata ...

may occur after a red cell transfusion in neonates, although there is an association between the two there is no evidence that the transfusion causes the disorder.

When to transfuse

What to transfuse

Safety considerations

See also

References

Further reading