Blood Transfusions In Premature Babies

Understanding the Risks and Rationale in Neonatal ICU

Transfusion
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A blood transfusion is a common procedure where donated blood is delivered to a patient through a line inserted into a vein. It is concerning enough when the procedure is performed on an adult. When it happens to a baby, particularly one in neonatal intensive care (NICU), it can be downright distressing.

Reasons for Blood Transfusions in NICU

In most cases, a blood transfusion is used to increase the number of red blood cells that carry oxygen to body tissues, including the brain and heart.

Transfusion can be given as either packed red blood cells (PRBC) or as whole blood. Individual components of blood can also be transfused, such as to increase the number of platelets to help stop bleeding.

In the NICU, babies may be given a red blood cell transfusion for several reasons. It may be needed in an emergency to replace blood loss from anemia without which shock or death might occur. More commonly, the blood is transfused to treat symptoms caused by anemia, such as apnea or bradycardia commonly seen in premature babies.

Risks of Blood Transfusion

Because donor blood is screened so carefully today, transfusions are considered to be incredibly safe in most developed countries. The risk of getting HIV from a blood transfusion, for example, is roughly one in two million. Similarly, the risk of hepatitis B has been reduced one in 171,000.

Modern blood banking techniques also allow for donated blood to be privately stored for long periods of time in the event of an emergency involving oneself or a family member.

The practice has lowered the risk of complications in preemies by reducing the number of donors a baby is exposed to.

Among the potential complications are transfusion reactions which can occur, albeit less frequently, in newborns.

Benefits of Transfusion in Newborns

Clearly, when given for shock or to treat severe blood loss, transfusions can be a lifesaver.

Other benefits may not be as obvious and include:

  • improved feeding
  • less respiratory distress
  • less apnea (where breathing is interrupted)
  • less trauma to the brain (due to the lack of oxygen)
  • earlier NICU discharge

Donating Blood for One's Own Baby

If you and your baby have the same blood type, you may be able to donate your own blood for transfusion. This is called a directed donation. While valuable, there are limitations to the procedure which may exclude you as a candidate. Among them:

  • The transfusion cannot be used in an immediate emergency. As with all blood donations, directed donations takes a week or two to prepare.
  • You cannot donate if you have just delivered a baby. Postpartum mothers must wait for six to eight weeks before any blood donation is allowed.
  • You need to be in good health. As a rule, blood donors must be over the age of 17 and weigh at least 110 pounds. An in-depth health survey is standardly performed to determine whether a candidate is eligible to donate.
  • You will need to pay for the cost of the procedure. Most insurances will not cover the cost of a directed donation. As such, you would need to pay lab testing costs as well as those associated with the actual draw and collection of blood.

    Sources:

    Bell, E. "When to transfuse preterm babies." Arch Dis Child Fetal Neonatal Ed. 2008; 93(6) F469-F473.

    Von Kohorn, I. and Ehrenkranz, R. "Anemia in the preterm infant: Erythropoietin versus erythrocyte transfusion - It's not that simple." Clinical Perinatology. 2009; 36(1):111-123.

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