ABSTRACT
Chapter Overview Two broad categories o f neonatal transfusion are those required subsequent
to maternal antibody destruction and those secondary to illnesses common in the premature patient. Mothers may form antibodies to paternally-derived antigens which they themselves lack and which enter their circulation during pregnancy. Maternal IgG can cross the placenta and cause both fetal red cell and platelet loss and will cause residual destruction in the neonate until these antibodies wane or are consumed. Two examples o f this phenomenon that are probably familiar to you are hemolytic disease o f the newborn (H D N ) due to anti-D or ABO-incompatibility and neonatal alloimmune thrombocytopenia (N A IT). Less common is red cell antigen incompatibility where the mother lacks a very common antigen, such as the e antigen. In these cases, support is typically limited to the specific component being destroyed. More complex in terms o f blood transfusion is the critically ill neonate. These patients frequently require multiple different components, and steady iatrogenic blood loss from necessary lab draws demands additional transfusions to maintain an adequate hemoglobin level. Intravenous volume constrictions provide a further challenge, particularly in the low-birth weight neonate.
