Optimizing platelet transfusion thresholds in preterm infants: a systematic review and narrative synthesis of impacts on survival and neurodevelopment.

BACKGROUND: The aim of this analysis was to evaluate the impact of different platelet transfusion thresholds on short-term and long-term outcomes in preterm infants, and to inform evidence-based, individualized transfusion strategies. MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Library (database initiation until December 2024) were searched. Comparative studies of restrictive transfusion strategies vs liberal transfusion strategies in thrombocytopenic neonates were included. The review protocol was prospectively registered (CRD42020169262). RESULTS: Of 4,102 reports screened, three randomized controlled trials and two cohort studies were included (1,851 patients). Restrictive transfusion strategies did not increase short-term adverse events and may potentially reduce the incidence of mortality and severe neurodevelopmental impairment at 2 years corrected age. DISCUSSION: /L) appear to be safe and may improve long-term prognosis. These findings support a shift toward more individualized, evidence-based transfusion practices in neonatal care.