BACKGROUND: Platelet transfusions are given to preterm infants with severe thrombocytopenia aiming to prevent haemorrhage. The PlaNeT2/MATISSE trial revealed higher rates of mortality and/or major bleeding in preterm infants receiving prophylactic platelet transfusions at a platelet count threshold of 50 × 109/L compared to 25 × 109/L. The extent to which this evidence has been incorporated into clinical practice is unknown, thus we aimed to describe current neonatal platelet transfusion practices in Europe. METHODS: We performed a prospective observational study in 64 neonatal intensive care units across 22 European countries between September 2022 and August 2023. Outcome measures included observed transfusion prevalence rates (per country and overall, pooled using a random effects Poisson model), expected rates based on patient-mix (per country, estimated using logistic regression), cumulative incidence of receiving a transfusion by day 28 (with death and discharge considered as competing events), transfusion indications, volumes and infusion rates, platelet count triggers and increment, and adverse effects. FINDINGS: We included 1143 preterm infants, of whom 71 (6.2%, [71/1143]) collectively received 217 transfusions. Overall observed prevalence rate was 0.3 platelet transfusion days per 100 admission days. By day 28, 8.3% (95% CI: 5.5-11.1) of infants received a transfusion. Most transfusions were indicated for threshold (74.2%, [161/217]). Pre-transfusion platelet counts were above 25 × 109/L in 33.1% [53/160] of these transfusions. There was significant variability in volume and duration. INTERPRETATION: The restrictive threshold of 25 × 109/L is being integrated into clinical practice. Research is needed to explore existing variation and generate evidence for various aspects including optimal volumes and infusion rates. FUNDING: Sanquin, EBA, and ESPR.

2 Department of Neonatology Poznan University of Medical Sciences Poznan Poland

Amsterdam UMC University of Amsterdam Emma Children's Hospital Pediatric Hematology Meibergdreef 9 Amsterdam the Netherlands

Centro Materno Infantil do Norte Unidade Local de Saúde de Santo António Porto Portugal

Charité Universitätsmedizin Berlin Berlin Germany

CHU de Rennes Rennes France

Department of Neonatal and Paediatric Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Neonatology Semmelweis University Budapest Hungary

Faculty of Health Sciences University of Bristol Bristol United Kingdom

Fondazione IRCCS Policlinico San Matteo Pavia Italy

Jessenius Faculty of Medicine University Hospital Martin Martin Slovakia

Karolinska Institute Stockholm Sweden

La Fe University Hospital Valencia Spain

Leiden University Medical Centre Leiden the Netherlands

Medical University Vienna Vienna Austria

National Maternity Hospital Dublin Ireland

National Perinatal Epidemiology Unit Oxford Population Health University of Oxford Oxford United Kingdom

NHS Blood and Transplant London United Kingdom

Oslo University Hospital Oslo Norway

Sanquin Research Department of Molecular Cellular Hemostasis Amsterdam the Netherlands

Sanquin Research Sanquin Blood Supply Foundation Amsterdam the Netherlands

University College Dublin Dublin Ireland

University Hospital Centre Zagreb University of Zagreb School of Medicine Zagreb Croatia

University Hospital Hradec Králové Hradec Králové Czech Republic

University Hospital Zurich Zurich Switzerland

University Medical Centre Ljubljana Ljubljana Slovenia

University Medical Centre Sarajevo Sarajevo Bosnia and Herzegovina

University of Ljubljana Faculty of Medicine Ljubljana Slovenia

University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca Romania

University of Oxford Oxford United Kingdom

UZ Leuven Leuven Belgium

Women's and Children's Division Southmead Hospital North Bristol NHS Trust Bristol United Kingdom

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