A MULTICENTER OBSERVATIONAL ASSESSMENT OF PLATELET TRANSFUSION IN NEONATAL INTENSIVE CARE UNITS

Background: Platelet transfusion is a widely employed therapeutic intervention in Neonatal Intensive Care Units (NICUs), particularly among preterm and critically ill neonates. Current evidence suggests that factors beyond thrombocytopenia alone often influence transfusion decisions, underscoring the need for context-specific data to inform evidence-based guidelines. Objective: This multicenter observational study aimed to evaluate the incidence, clinical determinants, and indications for platelet transfusions among neonates admitted to NICUs across multiple tertiary care hospitals in Sindh, Pakistan. Methodology: A prospective cohort study design was employed across selected tertiary care hospitals in Sindh over a five-month period. All neonates consecutively admitted to the NICUs during the study timeframe were included. Clinical, demographic, and laboratory data were extracted through comprehensive chart reviews. A structured, validated questionnaire was administered to assess the underlying justifications for each platelet transfusion episode. Results & Findings: A total of 401 neonates were enrolled. The mean birth weight (BW) was 2.34 ± 1.01 kg, and the mean gestational age (GA) was 34.4 ± 4.5 weeks. Platelet transfusions were administered to 37 neonates (9.2%). The majority of transfused neonates were either extremely preterm (<28 weeks; 40.5%) or term (≥37 weeks; 24.3%). The median pre-transfusion platelet count was 57 × 10⁹/L (range: 9–285 × 10⁹/L). Compared to their non-transfused counterparts, transfused neonates exhibited significantly lower BW and GA, elevated CRIB-II and SNAPPE-II scores (all p<0.001), and were more frequently admitted due to respiratory distress (p<0.001), hypoxic-ischemic encephalopathy (p=0.009), and hemolytic disease of the newborn (p<0.001). Multivariate logistic regression identified gestational age <28 weeks (p<0.001), mechanical ventilation (p=0.008), and platelet nadir ≤150 × 10⁹/L at admission (p<0.001) as independent predictors of transfusion. The primary clinical indications cited for the initial platelet transfusion were thrombocytopenia (86.5%), underlying disease pathology (78.4%), and severity of illness (37.8%). Conclusion: This multicenter analysis highlights substantial inter-patient variability in pre-transfusion platelet counts, with transfusion decisions frequently exceeding guideline-recommended thresholds. Beyond thrombocytopenia, multiple clinical parameters—particularly prematurity, respiratory compromise, and disease severity—emerged as significant determinants of transfusion practices. These findings underscore the necessity for standardized, evidence-based transfusion protocols tailored to the unique clinical settings of resource-limited neonatal care environments.