Red cells for top-up transfusions

Studies support restrictive transfusion thresholds.

Suggested transfusion thresholds for preterm neonates

Postnatal AgeSuggested transfusion threshold
Hb (g/L)
VentilatedOn oxygen/NIPPV**Off oxygen
1st 24 hours<120<120<100
≤week 1 (day 1-7)<120<100<100
week 2 (day 8-14)<100<95<75*
≥week 3 (day 15 onwards)<100<85<75*

Table applies to very preterm babies (<32 weeks); for later preterm/term babies the values for babies off oxygen may be used.

* It is accepted that clinicians may use up to 85 g/L depending on clinical situation.

** NIPPV, non-invasive positive pressure ventilation.

  • Generally transfuse 15 mL/kg for non-bleeding neonates.

  • Where the term or preterm neonate does not require resuscitation, undertake delayed cord clamping.

  • Minimise phlebotomy where possible, using small volume samples.

  • Ensure that paedipacks are available for emergency use by maternity and neonatal units.

  • Transfuse red cells for large volume neonatal and infant transfusion before the end of Day 5

    Transfusion rate: 5mL/kg/hr.