Preterm infants are at an increased risk for intracranial hemorrhage, as many are thrombocytopenic (<150,000 platelets/µL). Although there is little evidence for appropriate platelet transfusion thresholds in preterm infants, recent studies suggest a higher incidence of death and major bleeding for preterm infants who receive platelet transfusions. A new secondary analysis of the PENUT trial (a randomized clinical trial of erythropoietin neuroprotection in neonates) adds to this evidence base. In the cohort of 819 infants (52% male; mean gestational age, 25.5 weeks; birth weight, 798 g), 30% (245/819) received at least one platelet transfusion in the NICU. The risk of death or severe neurodevelopmental impairment at approximately two years of age was significantly higher in those infants who had received platelet transfusion(s) compared to those who did not—46.5% compared to 13.9%. Notably, the adjusted odds ratio for death or severe impairment was 2.43 (95% C.I., 1.24 to 4.76) after accounting for potential confounders. Further research is needed to elucidate the relationship between platelet count and risk of bleeding in preterm infants and determine appropriate platelet transfusion thresholds in preterm infants.
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