{"doi":"10.1111/trf.17914","title":"Consensus transfusion guidelines for a large neonatal intensive care network","abstract":"Neonates and infants hospitalized in the neonatal intensive care unit (NICU) frequently require blood product transfusions, but clinical practices vary widely. Many very low birth weight (VLBW) infants receive packed red blood cell (RBC) or platelet transfusions during their initial NICU stay, with incidence inversely proportional to gestational age at birth.1, 2 A recent study estimated that in infants less than 27 weeks gestation, 70% received RBCs, 34% received platelets, and 24% received plasma to promote coagulation during their NICU admission.3-5 These blood product transfusions are most often prophylactic, with clinical decisions made in response to numeric blood count values, as opposed to therapeutic transfusions in the context of active bleeding. Emerging evidence has suggested that some transfusion practices are harmful for certain NICU patients, such as platelet transfusions in preterm infants.6, 7 More broadly, transfusion reactions can occur with virtually all blood products.8 Although rare in the neonatal population,9 these reactions may be under-diagnosed, under-estimated, and under-reported in pediatric patients3 and some papers report that rates may be higher than in adult populations.9 Our intention was to establish optimal transfusion guidelines for our division and neonatal intensive care network, including 19 hospitals, based on a review of currently available literature. The terms “neonates” and “infants” are used throughout this manuscript to describe any patients hospitalized in the NICU. We identified blood product transfusion guidelines as a topic that could be amenable to significant quality improvement within our neonatal intensive care network. The modified Delphi method is a systematic, iterative approach geared toward developing consensus among a group of expert stakeholders.10, 11 This approach can be used to help form consensus in areas with divergent evidence base or when expert opinion is utilized. We used this method to identify and implement opportunities to align our transfusion practices with existing literature to optimize patient outcomes. We first defined the scope and specific aims of this consensus project, and then assigned neonatologists to small groups focused on specific topics. The groups reviewed and graded existing literature, and identified areas where a lack of evidence precluded clear recommendations. Each group developed literature-based guidelines and recommendations, which were shared within the broader neonatal care network. To assess agreement and consensus opportunities based on these guidelines, we posed questions to our neonatal care network providers. We inferred consensus when answers exceeded 7 on a Likert scale of 1 through 9 (1 being least likely and 9 being most likely). Our final consensus guidelines were presented to our Division of Neonatology in an open question-and-answer period. Agreement was sought, at times with live polling during the presentation. Following the larger group discussion, we edited our guidelines and distributed our finalized consensus guidelines among all network sites. We then assessed implementation of these guidelines and perspectives across our network 6 months after finalization. Platelets facilitate hemostasis and have important roles in inflammation, immunity, and vascular biology.12 Thrombocytopenia, defined as a platelet count less than 150,000 platelets/μL blood, most often occurs secondary to infection or other systemic pathology in NICU patients.13 Platelet transfusions are given most frequently to prevent major bleeding in thrombocytopenic patients, rather than in response to active bleeding.14 VLBW neonates are at increased risk for thrombocytopenia and are frequently transfused with platelets in the first 7 days of life.15 Platelet transfusion practices vary widely. Historically, clinical decision-making has been driven by concerns of increased risk of intraventricular hemorrhage (IVH) or other forms of major bleeding i","journal":"Transfusion","year":2024,"id":442664,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9628,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":48129,"name":"Stella T. Chou","orcid":"0000-0003-4333-6965","position":1,"is_corresponding":false},{"id":1097178,"name":"Sarvin Ghavam","orcid":null,"position":2,"is_corresponding":false},{"id":445483,"name":"Christopher S. Thom","orcid":"0000-0003-1830-9922","position":3,"is_corresponding":false},{"id":1177344,"name":"Lindsay Gilmore","orcid":null,"position":0,"is_corresponding":true}],"reference_count":49,"raw_metadata":null,"created_at":"2026-07-19T02:01:20.107161Z","pmid":"38884350","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}