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Pathophysiologic importance of platelets in neonatal necrotizing enterocolitis
Introduction The onset of necrotizing enterocolitis (NEC) is associated with decreased platelet counts in most patients within 24 hours, and the severity of this thrombocytopenia (defined as platelet counts <150 × 10 9 /L) typically correlates with the severity and…
Evidence-based guidelines for administering fresh frozen plasma in the NICU
Introduction Fresh frozen plasma (FFP) is the most commonly used hemostatic agent in neonatal intensive care units (NICUs), especially among critically ill neonates and for those who need extracorporeal life support (ECLS). Current guidelines on FFP administration in neonates are…
Novel approaches to identify NICU patients who would benefit from platelet transfusions
Introduction The underlying reasons for bleeding are multifactorial and likely include a combination of hematologic (i.e., platelet, von Willebrand factor [vWF], coagulation factors) and environmental factors such as vessel wall integrity, inflammation, and hemodynamic status. However, it is unknown to…
Recent advances in NICU platelet transfusions
Introduction Thrombocytopenia (defined as a platelet count <150 × 10 9 /L) is the second most common hematologic problem among neonates admitted to the neonatal intensive care unit (NICU), affecting 20% to 25% of this patient population. The incidence of…
Neonatal blood banking and transfusion: Current questions and controversies
Introduction Blood component transfusion is critical to modern neonatal medicine to support oxygen delivery, cardiac output, and maintain hemostasis, especially in the context of preventing bleeding or treating the bleeding neonate. Of all admissions to the neonatal intensive care unit…
NICU transfusion guidelines and strategies to minimize transfusions
Introduction Pathologic anemia is defined by a red blood cell (RBC) mass inadequate to meet the oxygen needs of tissues. Neonates often require red cell transfusions due to a decreased red cell mass brought about by acute blood loss. Preterm…
Erythropoietin and darbepoetin use in the NICU
Introduction Premature infants receive a greater number of transfusions and are exposed to a greater number of donors compared to any other hospitalized population. Transfusion guidelines are now used in many neonatal units; however, the search for the most appropriate…
Using targeted genetic panels to find the causes of neonatal hemolytic anemia
Definition, etiologies, and implications of neonatal hemolytic anemia Neonatal hemolytic anemias (NHA) are a group of pathologic conditions manifesting with low hemoglobin (Hb) levels and/or red blood cell (RBC) counts due to premature destruction of erythrocytes during the perinatal period.…
Risk factors for iron deficiency in neonates
Introduction Iron, although critically necessary, is both a good and a bad actor because excess unbound iron may be toxic. The physiologic window between the extremes of iron deficiency (ID) and excess is narrow. Official guidelines for identifying and managing…