Neonatal Intensive Care Unit Patients Receiving More Than 25 Platelet Transfusions

Objective A few patients in neonatal intensive care units (NICU) receive numerous platelet transfusions. These patients can become refractory, defined as transfusions of >= 10mL/kg failing to increase the platelet count by at least 5,000/mu L. Causes of, and best treatments for, platelet transfusion refractoriness in neonates have not been defined. Study Design Multi-NICU multiyear retrospective analysis of neonates receiving >25 platelet transfusions. Results Eight neonates received 29 to 52 platelet transfusions. All eight were blood group O. Five had sepsis, four were very small for gestational age, four had bowel resections, two Noonan syndrome, two had cytomegalovirus infection. All eight had some (19- 73%) refractory transfusions. Many (2-69%) of the transfusions were ordered when the platelet count was >50,000/mu L. Higher posttransfusion counts occurred after ABO-identical transfusions (p = 0.026). Three of the eight had late NICU deaths related to respiratory failure; all five survivors had severe bronchopulmonary dysplasia requiring tracheostomy for prolonged ventilator management. Conclusion Neonates who are high users of platelet transfusions appear to be at high risk for poor outcomes, especially respiratory failure. Future studies will examine whether group O neonates are more likely to develop refractoriness and whether certain neonates would have a higher magnitude of posttransfusion rise if they received ABO-identical donor platelets.