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Chapter 43 ■ Transfusion of Blood and Blood Products 305

b. May not be needed if prefiltered product is dispensed from transfusion service

c. Blood warmer not needed

6. Automated syringe pump with appropriate tubing and

needle (6–9)

a. Least hemolysis occurs with straight syringe pumps

b. Vascular access: RBCs may be transfused through

24-, 25-, or 27-gauge needles and short catheters but

not through 27- or 28-gauge central venous catheters.

c. The amount of hemolysis that results from infusion

of RBCs is directly proportionate to the age of the

blood and the rate of transfusion and inversely proportional to needle size.

d. Hyperkalemia, hemoglobinuria, and renal dysfunction may result if hemolyzed blood is transfused.

7. Normal saline flush (1 mL or more) to clear IV solution

from line.

Red Blood Cell Transfusions

A. Indications

1. Guidelines and justifications for transfusions are controversial because there are few studies that address the

appropriateness of various transfusion triggers in neonates. Therefore, indications for RBC transfusion vary

among different institutions.

2. Current guidelines for neonatal RBC transfusion therapy are given in Table 43.2 (10,11). In general

a. Infants with significant cardiopulmonary disease

require more RBC transfusion support.

b. Infants receiving minimal cardiopulmonary support, with acceptable weight gain, and with minimal

episodes of apnea and bradycardia, require less RBC

support.

3. Liberal versus conservative RBC transfusion

a. Studies on liberal versus conservative RBC transfusion practices have demonstrated mixed results in

terms of clinical benefit of liberal transfusion practices toward preventing apneic episodes and immediate neurologic sequelae (12,13).

b. Long-term neurodevelopmental benefit has not

been ascertained for either transfusion practice (14).

c. Several studies have documented a temporal relationship of RBC transfusions with the occurrence of necrotizing enterocolitis (NEC) in premature infants,

which supports a more restrictive transfusion practice

(15–19). Withholding feeds during transfusion may

have a protective effect from NEC (16).

d. The relationship between RBC transfusions and

NEC requires further evaluation in premature

infants.