OBJECTIVE: Despite lack of evidence supporting efficacy, prophylactic fresh frozen plasma and Octaplas transfusions may be administered to very preterm infants to reduce bleeding risk. International variation in plasma transfusion practices in neonatal intensive care units (NICUs) is poorly understood, therefore, we aimed to describe neonatal plasma transfusion practice in Europe. DESIGN: Prospective observational study. SETTING: 64 NICUs in 22 European countries, with a 6-week study period per centre between September 2022 and August 2023. PATIENTS: Preterm infants born below 32 weeks of gestational age. INTERVENTIONS: Admission to the NICU. MAIN OUTCOME MEASURES: Plasma transfusion prevalence, cumulative incidence, indications, transfusion volumes and infusion rates and adverse effects. RESULTS: A total of 92 of 1143 infants included (8.0%) received plasma during the study period, collectively receiving 177 transfusions. Overall prevalence was 0.3 plasma transfusion days per 100 admission days, and rates varied substantially across Europe. By day 28 of life, 13.5% (95% CI 10.0% to 16.9%) of infants received at least one plasma transfusion, accounted for competing risks of death or discharge. Transfusions were given for a broad range of indications, including active bleeding (29.4%), abnormal coagulation screen results (23.7%) and volume replacement/hypotension (21.5%). Transfusion volumes and infusion rates varied significantly; the most common volume was 15 mL/kg (range: 5-30 mL/kg) and the most common duration was 2 hours (range: 30 min to 6 hours). CONCLUSIONS: We found wide variation in plasma transfusion practices in Europe, highlighting the need for evidence to inform neonatologists in daily practice and guidelines, in particular for non-bleeding indications. TRIAL REGISTRATION NUMBER: ISRCTN17267090.

• Keywords
• Epidemiology, Intensive Care Units, Neonatal, Neonatology,
• MeSH
• Intensive Care Units, Neonatal * statistics & numerical data   MeSH
• Plasma * MeSH
• Humans MeSH
• Infant, Premature MeSH
• Infant, Newborn MeSH
• Blood Component Transfusion * statistics & numerical data   methods   adverse effects   MeSH
• Prospective Studies MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Geographicals
• Europe epidemiology   MeSH

BACKGROUND: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. STUDY DESIGN AND METHODS: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. RESULTS: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. DISCUSSION: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

• Keywords
• ICU, critically ill, intensive care unit, plasma, transfusion, transfusion practices,
• MeSH
• Intensive Care Units * statistics & numerical data   MeSH
• Plasma * MeSH
• Hemorrhage therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Blood Component Transfusion * statistics & numerical data   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH