Strategic measures taken in neonatal intensive care units (NICUs) could reduce the need for red blood cell transfusion ands improve health outcomes for premature infants, according to an article recently published in Seminars in Fetal and Neonatal Medicine, and this could benefit neonates with hemolytic disease of the fetus and newborn (HDFN).
While transfusions are critical in cases of severe anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells. or hemorrhage, they also carry risks that can lead to other health problems. In particular, frequent transfusions in NICU infants are associated with lung inflammation, potential eye complications, and even delays in neurodevelopment. Considering these risks, NICUs are actively working on ways to reduce the number of transfusions given to newborns without compromising their health.
Though blood supplies in technologically advanced countries are safer than ever, the process is not risk-free. For instance, transfusion-associated complications include circulatory overload, where the heart cannot handle the increased blood volume, and acute lung injury, where breathing becomes difficult after transfusion. While these issues are uncommon in infants, they remain serious enough to warrant careful assessment before every transfusion. In emergencies, however, such as life-threatening blood loss, a transfusion may be the best option for survival.
Recent studies have shown a link between frequent transfusions and certain health issues in NICU infants. For example, infants who undergo multiple red blood cell transfusions have a higher risk of developing bronchopulmonary dysplasia, a lung condition often seen in premature babies. In addition, retinopathy of prematurity, a condition that can cause blindness, has been found to be more common in infants who receive numerous transfusions. Researchers believe that these issues may stem from the way transfused blood interacts with fragile organs in newborns.
Read more about treatment and care of HDFN
NICUs now employ various strategies to lower the need for transfusions. Non-drug measures, such as delaying the clamping of the umbilical cord after birth and reducing unnecessary blood tests, help conserve blood volume in newborns. Furthermore, certain medications, such as erythropoietic stimulating agents, encourage the body to produce more red blood cells naturally, potentially reducing the need for transfusions.
At several Utah NICUs, the “Darbe Fridays” protocol has been introduced, administering the drug darbepoetin once a week to eligible infants. This targeted approach has helped increase the rate of transfusion-free survival in newborns, even at high-altitude hospitals where oxygen needs are typically greater. With ongoing improvements, these protocols show promise for creating safer environments for fragile infants in the NICU, helping them avoid unnecessary transfusions while still receiving the best possible care.
The authors noted, “[E]ffective transfusion reduction programs can be instituted in more NICUs. Doing so will not only reduce the number of transfusions given per transfused patient but will also increase the number of transfusion-free survivors.”
