Plasma transfusions in neonatal intensive care units: a prospective observational study.

Objective: Despite lack of evidence supporting efficacy, prophylactic fresh frozen plasma and Octaplas transfusions may be administered to very preterm infants to reduce bleeding risk. International variation in plasma transfusion practices in neonatal intensive care units (NICUs) is poorly understood, therefore, we aimed to describe neonatal plasma transfusion practice in Europe.

Design: Prospective observational study.

Setting: 64 NICUs in 22 European countries, with a 6-week study period per centre between September 2022 and August 2023.

Patients: Preterm infants born below 32 weeks of gestational age.

Interventions: Admission to the NICU.

Main outcome measures: Plasma transfusion prevalence, cumulative incidence, indications, transfusion volumes and infusion rates and adverse effects.

Results: A total of 92 of 1143 infants included (8.0%) received plasma during the study period, collectively receiving 177 transfusions. Overall prevalence was 0.3 plasma transfusion days per 100 admission days, and rates varied substantially across Europe. By day 28 of life, 13.5% (95% CI 10.0% to 16.9%) of infants received at least one plasma transfusion, accounted for competing risks of death or discharge. Transfusions were given for a broad range of indications, including active bleeding (29.4%), abnormal coagulation screen results (23.7%) and volume replacement/hypotension (21.5%). Transfusion volumes and infusion rates varied significantly; the most common volume was 15 mL/kg (range: 5-30 mL/kg) and the most common duration was 2 hours (range: 30 min to 6 hours).

Conclusions: We found wide variation in plasma transfusion practices in Europe, highlighting the need for evidence to inform neonatologists in daily practice and guidelines, in particular for non-bleeding indications.

Trial registration number: ISRCTN17267090.