Transfusion Burden in Neonates with Hypoxic–Ischemic Encephalopathy Undergoing Therapeutic Hypothermia

Abstract

Highlights What are the main findings? Over half (52.1%) of neonates with HIE undergoing therapeutic hypothermia received at least one blood component and coagulation/plasma-derived products, with a median of 2 transfusion episodes per infant; plasma and prothrombin complex concentrate were most frequently used. Clinically visible bleeding (aOR 12.95) and need for respiratory support (aOR 2.98) were independently associated with transfusion exposure, and transfused infants more often showed pathological brain MRI findings. What are the implications of the main findings? Transfusion burden in this population appears to reflect underlying disease severity rather than acting as an independent driver of neurological injury. These findings support the development of evidence-based, severity-adjusted transfusion strategies to optimize blood product stewardship in neonates with HIE. Abstract Background/Objectives: Neonates with hypoxic–ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) frequently develop coagulation abnormalities and bleeding complications, yet data on transfusion burden and its clinical correlates in this population remain limited. Materials and Methods: We performed a secondary analysis of a retrospective single-center cohort of neonates with HIE treated with TH between 2014 and 2022. Transfusion burden was defined as receipt of at least one blood component and coagulation/plasma products during hospitalization and the total number of transfusion episodes. Demographic, perinatal, biochemical, and clinical severity variables were collected. Univariable and multivariable logistic regression analyses were used to identify factors independently associated with transfusion exposure. Brain magnetic resonance imaging (MRI) findings were compared between transfused and non-transfused infants. Results: Among 142 included neonates, 74 (52.1%) received at least one blood product. The median number of transfusion episodes among transfused infants was 2 (IQR 1–3). Fresh frozen plasma and prothrombin complex concentrate were the most frequently administered products. Transfused infants showed higher markers of illness severity. In multivariable analysis, clinically visible bleeding (adjusted odds ratio [aOR] 12.95, 95% CI 1.34–124.97) and need for respiratory support (aOR 2.98, 95% CI 1.19–7.45) remained independently associated with transfusion exposure. Pathological brain MRI findings, including intracranial bleeding and hypoxic–ischemic injury, were more frequent among transfused infants. Conclusions: blood components and coagulation/plasma-derived products transfusions are common in neonates with HIE undergoing TH and appear to primarily reflect underlying disease severity. These findings highlight the need for optimized, evidence-based transfusion strategies in this vulnerable population.