Standardizing prophylactic platelet transfusions at 10 mL/kg for neonates reduced platelet exposure while maintaining safety, with no observed increases in bleeding or transfusion frequency, according to results from a study on fetal and neonatal alloimmune thrombocytopenia (FNAIT) published recently in Blood.
This hospital-wide initiative, implemented in a quaternary NICU, represents a significant advancement in optimizing care for preterm infants. By reducing unnecessary platelet transfusions, this approach could align with efforts to conserve limited platelet supplies.
Thrombocytopenia, a condition where platelet levels drop below 150,000/µL, affects 70% of extremely low birth weight infants in NICUs. Platelet transfusions, although intended to prevent bleeding, have been linked to adverse outcomes, including respiratory complications and neurocognitive impairments, due to physiological differences between adult and neonatal platelets. Prior research established the efficacy of 10 mL/kg transfusions in treating thrombocytopenia, guiding this initiative.
“A standardized prophylactic platelet transfusion dose of 10mL/kg was established through hospital-wide collaborative efforts,” the study’s authors wrote. “We used clinician education and electronic medical record technologies to improve platelet transfusion practices within our NICU, reducing platelet exposures that have been linked with adverse outcomes in preterm neonates.”
Baseline data revealed that only 14% of platelet transfusions adhered to the recommended 10 mL/kg dose, with most dosed at 15–20 mL/kg. To address this, a series of interventions was implemented. The first phase involved staff education through messaging, reminders, and discussions. The second phase reinforced guidelines through newsletters and team huddles. The final phase used electronic medical record updates, setting default transfusion doses to streamline ordering.
Read more about FNAIT treatment and care
These interventions were monitored over two years, encompassing 165 transfusions across 55 neonates. Compliance with the 10 mL/kg dosing standard rose to 88%, demonstrating sustained improvements in practice. Importantly, this shift did not lead to increased bleeding within 72 hours or higher rates of subsequent transfusions within 36 hours. In addition, hospital-wide changes reduced total platelet transfusions by 44% within six months.
For patients and families, this advancement could ensure safer treatment while minimizing the risks associated with excessive platelet exposure. Preterm infants, already vulnerable to complications, benefit from tailored interventions that reduce potential harm. Families can take comfort in knowing that these efforts prioritize both efficacy and safety.
This study highlights the value of collaborative approaches and technology in transforming neonatal care. By standardizing practices and fostering consensus among clinicians, the initiative sets a precedent for improving outcomes in vulnerable populations while preserving essential resources.
