Preterm delivery before
establishment of normal red cell and iron stores in last trimester.
Blood loss for Laboratory testing.
Expansion of blood volume with growth.
Physiological cessation of red cell synthesis
in the first 6 weeks after birth.
Although these factors combine to result in the
‘normal’ fall in haemoglobin concentration in the first 6-9 weeks after birth,
this is accompanied by improved oxygen unloading capacity as 2,3-DPG levels rise,
so that tissue oxygen delivery may improve despite reduced oxygen carrying
capacity. Thus the possible benefits of transfusion need to be balanced against
the known (and unknown) risks for each individual baby.
Indications for Transfusion
Shock due to blood loss.
Babies with cardiorespiratory disease.
Transfuse if haematocrit:
<40 if unwell (ventilated, <1000g, ongoing
< 35 if moderate lung disease (O2
requirement > 30%, significant apnoeas and bradycardia)
< 30 if mild residual lung disease (CPAP or
low rate ventilation in ≤ 30% O2).
Stable growing babies < 6 weeks
Transfuse if haematocrit < 30 and baby
symptomatic (recurrent apnoea and bradycardia, failure of weight gain).
Baby for surgery.
Stable growing babies > 6 weeks old.
Transfuse only if haematocrit < 25 and
baby symptomatic. Transfusion at this age will inhibit the normal onset
of erythropoiesis and should usually be discussed with a Specialist.
Oral iron supplements should be started at 4 weeks of age.
Informed consent must be obtained unless the
situation is life threatening.
Consent is documented on a consent form
(Agreement to Treatment CR111).
However, verbal consent by a parent is
acceptable provided it is documented in baby’s chart, until written consent
For infants who are under 1000g
and less than 10 days old, or infants who are likely to need multiple
transfusions within the first few weeks, order a mulitpack. This will
provide 4 paediatric packs of red cells from a single donor, thereby
reducing donor exposure.
Small babies (<1500g) in the first week of
life: 10ml/kg over 2h.
Larger babies and older babies: 15ml/kg over
2h to maximise haemoglobin rise while minimising numbers of transfusions
1mg/kg half way through the transfusion to minimise volume load.
JL and Bhutani VK. Role of furosemide therapy after booster-packed
erythrocyte transfusions in infants with bronchopulmonary dysplasia. J Pediatr 1990;117, 965-8.
H, Greiner B, Linderkamp O. Effect of blood transfusion on
cardiorespiratory abnormalities in preterm infants. Arch Dis Child 1995;
VYH and Gan TE. Red cell transfusion in the preterm infant. J Pediatr
Child Health 1994; 30;301-9.
& Newborn Committee, Canadian Paediatric Society. Guidelines for
transfusion of erythrocytes to neonates and premature infants. Can Med
Assoc J 1992; 147: 1781-6.