Red Blood Cell Transfusion for Preterm and Term Infants in the NICU

Red blood cell (RBC) transfusion practices in neonatal intensive care units are variable. Determining which patients should be transfused, and the specific hemoglobin or hematocrit thresholds, remains a recurring challenge in neonatal intensive care. Although some well-conducted randomized controlled trials and short-term follow-up studies exist for premature infants, data on term infants remain limited. Most information on term infants is derived from heterogeneous observational studies or expert consensus guidelines intended for a wider pediatric critical care population. In this review, we summarize the current literature on RBC transfusions in preterm and term infants, discuss unique characteristics of critically ill infants with varying comorbidities, and provide general strategies to guide the neonatologist in deciding when to transfuse RBCs. We also review specific considerations during RBC transfusion, such as volume, rate, and preparation as well as strategies to decrease the need for RBC transfusions.