Recommendations for transfusion therapy in neonatology.

The indications for transfusion therapy in the neonatal period are based on specific knowledge of various aspects of this particular period of life, such as the dynamic interaction of the mother-placenta-foetus/ neonate, the pathophysiological changes in the perinatal and neonatal periods and the profound haematological modfications that are characteristic of the first weeks of life. Furthermore, the physiological immaturity of various organs and systems can expose neonates, in particular those with a very low birth weight (VLBW) (Appendix I), to metabolic alterations following the transfusion of various blood components and the additives in them, and to infectious and immunological risks, such as Graft-versus-Host disease (GVHD). This implies the need for close and continuous collaboration between paediatricians-neonatologists and transfusion medicine specialists in order to obtain "dedicated" blood components, both with regards to quality and quantity, able to meet the particular needs of the neonate, especially considering the now increased survival of extremely low birth weight (ELBW) babies. ELBW and "critically ill" neonates are categories of patients with high transfusion needs, even though the number of transfusions given to premature neonates has progressively decreased over the last decade. It is, however, essential to establish appropriate transfusion criteria for these subjects. The scientific contributions on transfusion medicine in the neonatal period derive predominantly from consensus of opinions rather than controlled studies and the lack of clear scientific evidence makes it difficult to formulate high-grade recommendations based on solid levels of evidence. Furthermore, it should be appreciated that neonatal transfusion medicine is, like all other scientific fields, a continuously evolving discipline. These Recommendations, which represent the opinions of the authors and include evidencebased data, when available, have been formulated to facilitate the implementation of uniform transfusion practices. They are not intended to provide absolute indications, but aim to be a "guide" which nevertheless guarantees individual healthcare professionals freedom of choice in the various different clinical situations. This document deals with pre-transfusion tests, indications for the transfusion of blood components, characteristics of the blood components and methods of their administration for neonates. Details on the levels of evidence and strengths of the recommendations are provided in Appendix II. This document does not consider the indications for the use of blood derivatives and some highly specialised, life-saving techniques used in particular emergencies, such as extracorporeal membrane oxygenation and cardiopulmonary bypass.