Adherence to a restrictive platelet transfusion guideline in a neonatal surgical population

jpedsurg.org

In 2019, the PlaNeT-2 trial reported an increased risk of death and/or major bleeding among neonates transfused with platelets at liberal compared to restrictive thresholds. However, especially in the perioperative setting, clinicians often administer platelet transfusions to neonates at higher platelet count thresholds in hopes of reducing the risk of bleeding. In this study, we investigated if platelet transfusion practices changed in neonates with primary surgical diagnoses after the implementation of a restrictive platelet transfusion guideline in January of 2019.

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Article · Jan 2026 · 1 min read

In brief

This study examines whether neonatal surgical teams adopted restrictive platelet transfusion thresholds following 2019 guideline changes based on the PlaNeT-2 trial, which showed liberal transfusion strategies increased mortality and bleeding risk. The research addresses the gap between evidence-based recommendations and actual perioperative practice in this vulnerable population.

- PlaNeT-2 trial (2019) showed restrictive platelet transfusion thresholds reduced mortality and major bleeding in neonates vs. liberal thresholds. - Clinicians often exceed evidence-based thresholds perioperatively, transfusing at higher platelet counts to prevent bleeding. - Study evaluated whether restrictive guideline implementation (Jan 2019) changed transfusion practices in surgical neonates. - Restrictive transfusion strategies may improve outcomes; adherence to guidelines in high-risk surgical populations remains uncertain.

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