Changes in neonatal transfusion practice after dissemination of neonatal recommendations

OBJECTIVE: To evaluate the change in neonatal transfusion practices after the introduction of national recommendations for transfusion of blood products to neonates in 2006. METHODS: A questionnaire-based survey on neonatal transfusion practice of 79 Italian NICUs was completed in 2008. Results were compared with those obtained from a previous national Italian neonatal transfusion-practice survey performed in 2001. RESULTS: Responses were received from 62 of 79 (78.5%) neonatal units. Prophylaxis for transfusion-transmitted cytomegalovirus infection in 2001 and 2008 had been performed in 96.8% and 98.4% of NICUs, respectively. Filter leukoreduction of red blood cell donor units was preferred over cytomegalovirus antibody testing to obtain cytomegalovirus-safe blood components. Prophylaxis for graft-versushost disease increased from being performed at 61.3% of neonatal units in 2001 to 77.4% in 2008 (P = .08, Pearson χ²), whereas usage of dedicated red blood cell donor units (paedipack system), permitting multiple transfusions from the same unit, improved from 53.2% to 82.2% (P = .001, Pearson χ²). The 2008 survey documented a continuation of wide variability in transfusion practice for fresh-frozen plasma and platelet concentrates. CONCLUSIONS: This nation-wide Italian self-report survey highlighted improvements in NICU transfusion practice after the neonatal recommendations issued in 2006. Prophylaxis for transfusion-transmitted cytomegalovirus infection continued with nearly total adherence to national recommendations, and both prophylaxis for graft-versus-host disease and paedipack-system usage suggested a trend of improvement of adherence rates. The continuing wide diversity observed among neonatal units in fresh-frozen plasma and platelet-concentrate transfusion practice may indicate a lack of acceptable criteria for the administration of these blood products.