REVIEW OF NEONATAL RED-CELL TRANSFUSION PRACTICES

In the United States in 1991, 290 000 or 7.1% of the 4 110 907 live bi rths were premature infants; 53 299 or 1.3% were infants with birth we ights of less than 1500 grams. Many if not all of these very low birth weight infants will require red blood cell transfusions for one of se veral reasons. These include exchange transfusions for hyperbilirubine mia, but most often transfusions are simple small volume transfusion a lso called 'topper' transfusions. Most of these small volume transfusi ons are given for iatrogenic blood loss or 'bleeding into the laborato ry.' Studies have demonstrated that the sicker the infant, the more bl ood sampling is needed and the greater the exposure to red blood cell (RBC), platelet and plasma products. Simple RBC transfusions may also be given for specific clinical indications or to maintain a predetermi ned hemoglobin concentration. This manuscript will review the criteria for RBC transfusion in neonates and selection of product as regards a nticoagulant and specialized processing. In addition, the results of r ecombinant erythropoietin (r-EPO) clinical trials in neonates will be discussed.