Examining Practice Variation Used for Packed Red Blood Cell Transfusions for Preterm Infants in Neonatal Intensive Care Units Across the United States

Purpose: Researchers report associations between packed red blood cell (PRBC) transfusions and morbid outcomes in preterm infants. Published standards are lacking for giving PRBC transfusions to preterm infants in the neonatal intensive care unit (NICU). This study examined standard practices reported by nurses across the United States (US) for administering PRBC transfusions to preterms to identify variation in practice which may contribute to the relationship of PRBC transfusions and morbidity. Design and Methods: A 23-item questionnaire developed using REDCap based on literature and nursing experience of experts on the procedure of administering PRBC transfusions to preterm infants was distributed via social media and email to NICU nurses across the US. Results: A total of 757 responses received and 518 completed responses were analyzed from level IV (48%) and level III (49%) NICU nurses in 47/50 US states. Most (94%) report PRBCs are ordered for anemia. Most (74%) report NICU policies do not specify warming PRBC transfusions prior to infusing; 10% (n = 53) specifically indicate they warm PRBC transfusions. Only 2% report using a blood warmer device. NICU nurses in the US (66%) reported feedings are altered during the PRBC transfusion. A 97% of nurses reported their NICU employs a specific physiologic assessment policy during PRBC transfusions. The two most common infusion sites used are (99%) peripheral IV as preferred and an umbilical venous catheter (74.5%) as next best option. Conclusion: This study reveals inconsistencies in PRBC transfusion practices in US NICUs. Vast inconsistencies were shown in warming transfusions and in feeding practices surrounding PRBC transfusions. Future research should examine these variations in PRBC transfusion practices for any contributions to the relationship of PRBC transfusions and morbidity in preterm infants. A standard guideline should be developed based on the research evidence to guide nurses in administering preterm PRBC transfusions.