Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change.

Objective To evaluate red blood cell (RBC) transfusion practices in preterm neonates before and after protocol change. Methods All preterm neonates (<32 weeks of gestation) admitted between 2008 and 2017 at our neonatal intensive care unit were included in this retrospective study. Since 2014, a more restrictive transfusion guideline was implemented in our unit. We compared transfusion practices before and after this guideline change. Primary outcome was the number of transfusions per neonate and the percentage of neonates receiving a blood transfusion. Secondary outcomes were neonatal morbidities and mortality during admission. Results The percentage of preterm neonates requiring a blood transfusion was 37 center dot 5% (405/1079) before and 32 center dot 7% (165/505) after the protocol change (P = 0 center dot 040). The mean number of transfusions given to each transfused neonate decreased from 2 center dot 93 (standard deviation (SD) +/- 2 center dot 26) to 2 center dot 20 (SD +/- 1 center dot 29) (P = 0 center dot 007). We observed no association between changes in transfusion practices and neonatal outcome. Conclusion The use of a more restrictive transfusion guideline leads to a reduction in red blood cell transfusions in preterm neonates, without evidence of an increase in mortality or short-term morbidity.