Clinical instability is defined by the presence of at least one of the following: | |||
| |||
Postnatal age | Gestational age | Hemoglobin (hematocrit) thresholds for transfusion | |
Neonates with clinical instability | Neonates without clinical instability | ||
0-7 days | Any | 11 g/dL (32%) | 10 g/dL (29%) |
8-14 days | <35 weeks | 10 g/dL (29%) | 8 g/dL (24%) |
≥35 weeks | 7 g/dL (21%)* | 7 g/dL (21%)* | |
≥15 days | <35 weeks | 8 g/dL (24%) | 7 g/dL (21%)¶ |
≥35 weeks | 7 g/dL (21%)* | 7 g/dL (21%)* |
CPAP: continuous positive airway pressure; RBC: red blood cell; NICU: neonatal intensive care unit; ECMO: extracorporeal membrane oxygenation; AOP: anemia of prematurity; PPHN: persistent pulmonary hypertension of the newborn; Hgb: hemoglobin; HCT: hematocrit; SGA: small for gestational age.
* This threshold is appropriate for most neonates in these categories, provided they are not SGA (in which case the preterm thresholds should be used). The Hgb <7 g/dL (HCT <21%) threshold applies to clinically stable neonates and to critically ill neonates who are hemodynamically stabilized (ie, not hypotensive and not requiring escalating inotropic/vasopressor support). A higher threshold may be warranted in neonates with severe or progressive shock and/or severe hypoxemia. In addition, separate thresholds are used for neonates with any of the conditions listed above in the legend.
¶ For preterm neonates with AOP who otherwise appear well and are asymptomatic but who continue to have significant anemia (ie, Hgb <7 g/dL or HCT <21%) at four to six weeks after birth, measuring the reticulocyte count can help guide decisions regarding RBC transfusion. If the absolute reticulocyte is ≥100,000/microL (≥2%), RBC transfusion may not be necessary.Do you want to add Medilib to your home screen?