Red blood cell (RBC) transfusion practices in neonatal intensive care units are variable. Determining which patients should be transfused, and the specific hemoglobin or hematocrit thresholds, remains a recurring challenge in neonatal intensive care. Although some well-conducted randomized controlled trials and short-term follow-up studies exist for premature infants, data on term infants remain limited. Most information on term infants is derived from heterogeneous observational studies or expert consensus guidelines intended for a wider pediatric critical care population. In this review, we summarize the current literature on RBC transfusions in preterm and term infants, discuss unique characteristics of critically ill infants with varying comorbidities, and provide general strategies to guide the neonatologist in deciding when to transfuse RBCs. We also review specific considerations during RBC transfusion, such as volume, rate, and preparation as well as strategies to decrease the need for RBC transfusions.
Despite an incidence ranging from 8% to 30.6% across various studies, a lack of guidelines about the management of respiratory distress syndrome (RDS) in late preterm infants (LPIs) exists. Clinical criteria for surfactant therapy and mode of administration remain highly variable in this population. Although surfactant administration is time-sensitive, there is no clear consensus among clinicians on the optimal timing of administration in LPIs. In this review, we summarize the current evidence of the role of antenatal steroids in the prevention of RDS in LPIs, examine current understanding of the pathophysiology of RDS in this population, and review clinical criteria, ideal timing, and mode of surfactant administration.
Primary cardiomyopathies are associated with poor neonatal outcomes, including high mortality rates. Neonatal care of infants with significant prenatal cardiac diagnoses may warrant additional management considerations beyond standard Neonatal Resuscitation Program guidelines. Many of these management considerations are described in the Neonatal Resuscitation, 9th Edition, which details several congenital cardiac lesions and their delivery room management; still, a prenatal primary cardiomyopathy diagnosis warrants additional, unique predelivery care planning, especially in more severe cases. This case report describes our multidisciplinary team's approach to predelivery planning and neonatal resuscitation and stabilization of an infant with prenatal diagnosis of severe cardiomyopathy. The case underscores that with continued refinement in patient selection, timing, and technology, a similar approach undertaken in a future case might yield a favorable outcome.
