This article by Josephson and colleagues highlights the wide variation in practice related to platelet transfusions for the treatment of thrombocytopenia in neonates. Their survey of American and Canadian neonatologists demonstrates differences in not only platelet transfusion thresholds but also the type of platelet products used. The authors conclude by suggesting a need for large, definitive clinical trials to provide guidance and reduce variability in practice. Despite a rather low response rate that was likely the result of a broad sample frame strategy that included pediatricians that do not practice neonatal intensive care medicine, the questionnaire itself was robust. The survey addressed important considerations such as different indications, treatments, and settings. Although the article addresses what neonatologists say they do and not what they actually do, the article highlights the need for clinical trials assessing platelet transfusion thresholds.

– Dean A. Fergusson