RBC transfusion variability in NICUs

A retrospective analysis of data from four NICUs that were following the same RBC transfusion guidelines showed wide variability in the number of RBC transfusions administered, from 5 per 1000 NICU days to 22 per 1000 NICU days. NICUs with lower transfusion rates had practices in place to prevent anemia – delayed cord clamping, use of cord blood for admission laboratory tests, and use of darbepoietin for selected babies.These anemia-prevention strategies saved approximately $300,000 each year in avoided transfusions. The two NICUs with the lowest transfusion rates also had lower rates of necrotizing enterocolitis and grades 3 – 4 intraventricular hemorrhage.

Why do four NICUs using identical RBC transfusion guidelines have different gestational-age adjusted RBC transfusion rates? Henry et al. J Perinatology Sept 2014.