Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 29:288:114797.
doi: 10.1016/j.jpeds.2025.114797. Online ahead of print.

Temporal Trends in Red Blood Cell and Platelet Transfusion Thresholds for Extremely Low Birth Weight Infants

Ravi M Patel  1 , Jeanne E Hendrickson  2 , Rebecca Birch  3 , Daniel W Bougie  4 , Brian Branchford  5 , Xuxin Chen  6 , Brian Custer  7 , Robert A Desimone  8 , Erika Edwards  9 , Ruchika Goel  10 , Jerome Gottschall  4 , Eldad A Hod  11 , Morvarid Moayeri  12 , Oliver Karam  13 , Elizabeth F Stone  11 , Naomi L C Luban  14 , Cassandra D Josephson  15 , Martha Sola-Visner  16 ; NHLBI Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P)
Affiliations

Temporal Trends in Red Blood Cell and Platelet Transfusion Thresholds for Extremely Low Birth Weight Infants

Ravi M Patel et al. J Pediatr. .

Abstract

Objective: To evaluate if hematologic thresholds for red blood cell (RBC) and platelet transfusions changed over time following publication of new evidence from randomized trials in a multicenter cohort of extremely low birth weight (ELBW) infants.

Study design: We analyzed data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-IV-Pediatrics study from April 2019 through December 2023. We compared pretransfusion hemoglobin and platelet counts closest to each transfusion within 24 hours by year using linear mixed models and used model interaction terms to determine if trends over time differed by postnatal weeks.

Results: We evaluated 981 ELBW infants. For trends in RBC transfusion thresholds, 785 infants (80%) received 5182 RBC transfusions, of which 4835 (93%) had a pretransfusion hemoglobin value. Pretransfusion hemoglobin declined over time (P < .0001), with trends differing by postnatal week (interaction P = .005). The greatest year-over-year decline in pretransfusion hemoglobin was in the third postnatal week or later. For platelet transfusions, 221 infants (23%) received 934 platelet transfusions, of which 900 (96%) had a corresponding pretransfusion platelet count. There was no change in pretransfusion platelet count over time (P = .24). These trends did not differ by postnatal week (interaction P = .14), although pretransfusion platelet counts were lower after the first postnatal week (P < .001).

Conclusions: In this cohort of US centers, we observed declines in pretransfusion hemoglobin but not pretransfusion platelet counts from 2019 to 2023. These findings suggest evidence from recent RBC and platelet transfusion threshold trials may have been differentially translated into clinical practice for ELBW infants.

Keywords: blood; infant; platelet; preterm; red blood cell; transfusion.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors were supported by research contracts from the National Heart, Lung, and Blood Institute (NHLBI Contracts HHSN 75N92019D00032, HHSN 75N92019D00034, 75N92019D00035, HHSN 75N92019D00036, and HHSN 75N92019D00037). Additional funding was provided by the National Institute of Child Health and Human Development (NICHD). Drs Patel, Josephson and Sola-Visner received funding from NHLBI grants UG3HL173303 and UH3HL173303. The authors have no conflicts of interest to disclose. Special thank you to ICCBBA, the international standards organization responsible for the management and development of the ISBT 128 Standard for access to the ISBT 128 database. https://www.iccbba.org/. The funding source designated an investigator-led steering committee, which independently oversaw the design and conduct of the study and interpretation of the data, preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.

References

    1. Patel RM, Hendrickson JE, Nellis ME, Birch R, Goel R, Karam O, Karafin MS, Hanson SJ, Sachais BS, Hauser RG, Luban NLC, Gottschall J, Josephson CD, Sola-Visner M; National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P). Variation in Neonatal Transfusion Practice. J Pediatr. 2021. Aug;235:92–99.e4. doi: 10.1016/j.jpeds.2021.04.002. Epub 2021 Apr 7. - DOI - PMC - PubMed
    1. Kirpalani H, Bell EF, Hintz SR, et al. Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. N Engl J Med. Dec 31 2020;383(27):2639–2651. doi: 10.1056/NEJMoa2020248 - DOI - PMC - PubMed
    1. Franz AR, Engel C, Bassler D, et al. Effects of Liberal vs Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants: The ETTNO Randomized Clinical Trial. JAMA. Aug 11 2020;324(6):560–570. doi: 10.1001/jama.2020.10690 - DOI - PMC - PubMed
    1. Curley A, Stanworth SJ, Willoughby K, et al. Randomized Trial of Platelet-Transfusion Thresholds in Neonates. N Engl J Med. Jan 17 2019;380(3):242–251. doi: 10.1056/NEJMoa1807320 - DOI - PubMed
    1. Josephson CD, Glynn S, Mathew S, Birch R, Bakkour S, Baumann Kreuziger L, Busch MP, Chapman K, Dinardo C, Hendrickson J, Hod EA, Kelly S, Luban N, Mast A, Norris P, Custer B, Sabino E, Sachais B, Spencer BR, Stone M, Kleinman S; National Heart, Lung, and Blood Institute (NHLBI) Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P). The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P): A research program striving to improve blood donor safety and optimize transfusion outcomes across the lifespan. Transfusion. 2022. May;62(5):982–999. doi: 10.1111/trf.16869. Epub 2022 Apr 19. - DOI - PMC - PubMed

LinkOut - more resources