Neonatal Plasma Transfusion: An Evidence-Based Review

•There is limited available evidence to guide the use of fresh-frozen plasma in the neonatal unit.•Routine admission coagulation screening is inappropriate in neonates.•Plasma should not be used to correct abnormalities in coagulation studies alone.•Plasma should not be used for volume replacement or routinely for prevention of intraventricular hemorrhage.

Several clinical scenarios for plasma transfusion are repeatedly identified in audits, including treatment of bleeding in association with laboratory evidence of coagulopathy, correction of disseminated intravascular coagulation, prevention of intraventricular hemorrhage, management of critically ill neonates (eg, during sepsis or as a volume expander), or correction of markers of prolonged coagulation in the absence of bleeding. The findings of at least one national audit of transfusion practice indicated that almost half of plasma transfusions are given to neonates with abnormal coagulation values with no evidence of active bleeding, despite the limited evidence base to support the effectiveness of this practice. Plasma transfusions to neonates should be considered in the clinical context of bleeding (eg, vitamin K dependent), disseminated intravascular coagulation, and very rare inherited deficiencies of coagulation factors. There seems to be no role for prophylactic plasma to prevent intraventricular hemorrhage or for use as a volume expander.