Platelet and red cell transfusions for neonates: lifesavers or Trojan horses?

Red blood cell (RBC) and platelet transfusions are frequently administered to neonates. Up to 90% of extremely low birth weight infants and 58% of preterm infants (<32 weeks gestational age (GA)) receive one or more RBC transfusions. Severe thrombocytopenia (platelet count <50x109/L) occurs in approximately 5–10% of preterm neonates, of which over 75% are treated with platelet transfusions. Unfortunately, due to lack of high-quality evidence, neonatal transfusion guidelines are largely based on expert opinion. In recent years, neonatal transfusion research has gained momentum, challenging preconceptions regarding transfusion efficacy by showing that the patient benefits are oftentimes limited. In line with data from studies in adults and contrary to commonly held beliefs, recent neonatal trials suggest that transfusions may indeed have inadvertent harmful effects, such as increased risk of bleeding or mortality.