Blood transfusion therapy in the newborn.

This review deals with the various indications, the choice of blood products and the main aspects of their administration for transfusing neonates. Some special problems peculiar to neonatal age, that both neonatologists and blood transfusion services have to take into account, are emphasized. Exchange transfusion in the procedure most frequently used in blood transfusion therapy of neonatal hyperbilirubinaemia of various aetiology, severe anaemia and hyperviscosity due to polycythaemia. The procedure also represents a rational therapeutic approach in the bleeding thrombocytopenic newborn. More recently exchange transfusion has been utilized in the management of DIC, RDS and sepsis. Besides its advantages, metabolic, haemorrhagic and cardiac hazards of this "massive transfusion" are considered. Just as at any other age, the red cell preparation is the blood component most frequently utilized in the transfusion therapy of the neonate, considering not only the treatment of anaemia without hypovolaemic shock, but also the cases of iatrogenic blood loss, a common problem in the high risk neonatal intensive care unit. As transfusion of small increments of blood may often be required for the sick neonate and premature infant, different methods to cope with such conditions are discussed.