Article of the Month – August 2026 – Shannon Farmer, Susan Goobie and Patricia Davenport

Patient Blood Management (PBM) in neonates requires a shift toward restrictive transfusion strategies to mitigate long-term immunological risks and improve clinical outcomes. A retrospective study of 1,300 neonates undergoing non-cardiac surgery at Boston Children's Hospital identified a 22.8% transfusion rate and a 51% incidence of over-transfusion, defined as postoperative hemoglobin levels exceeding 12 g/dL. Notably, data indicates a dose-response relationship where every 5 mL/kg increase in red blood cell volume correlates with a 1.05-fold increase in 30-day mortality. Because neonates possess unique blood physiology—predominantly fetal hemoglobin—clinical decisions must prioritize physiological markers over arbitrary hemoglobin thresholds. Blood transfusion acts as a complex biological intervention, necessitating multidisciplinary collaboration between anesthesiologists and neonatologists to optimize blood health and minimize unnecessary exposure to adult blood products.