Neonatal trauma resuscitation: Successful use of low-titer O+ whole blood in a 4-day-old infant with hemorrhagic shock.

Abstract

Background: Neonatal trauma resuscitation is particularly challenging in cases of profound hemorrhagic shock. Low-titer group O+ whole blood (LTOWB+) has emerged as a potentially effective option in pediatric trauma, but its use in neonates is debated due to risks such as D-alloimmunization. In life-threatening emergencies, decisions must carefully balance immediate survival benefits against long-term risks.

Study design and methods: We present a case report of a 4-day-old neonate transported as a Level 1 trauma following a dog attack to the head, resulting in hemorrhagic shock and cardiac arrest. Upon arrival to the trauma bay, the patient was pulseless, with unsuccessful intraosseous and intravenous vascular access attempts. Access was eventually achieved using an umbilical venous catheter, enabling administration of LTOWB+.

Results: Administration of LTOWB+ resulted in the return of spontaneous circulation, improved perfusion, and hemodynamic stabilization. The patient remained alive at the 6-month follow-up. LTOWB+ facilitated rapid correction of hemorrhagic shock with no immediate complications observed.

Discussion: This case underscores the challenges of neonatal trauma resuscitation, including vascular access and the use of LTOWB+. LTOWB+ proved lifesaving, enabling rapid correction of acidosis and an improved outcome. Although concerns persist regarding LTOWB+ administration, the immediate survival benefits outweigh the risks, supported by evidence demonstrating its efficacy and safety. This case highlights the need for adaptability and a systematic approach to managing complex neonatal trauma scenarios. We argue that LTOWB+ is poised to become a pillar of pediatric resuscitation, providing a lifesaving, efficient, and safe option even in the newborn.