Iatrogenic blood loss is a substantial contributor to anaemia and transfusion exposure in preterm infants — a harm caused entirely by care rather than by prematurity. A Cochrane review has now assembled the randomised evidence on strategies to reduce it, searching to September 2025.
The comparisons it sets out map the practical options: cord or placental blood sampling instead of sampling the infant; non-blood fluids such as urine or saliva instead of blood; micro-sampling devices; devices that reintroduce blood after analysis; strict protocols limiting how often neonatal blood is taken; and combinations of these.
The review's own framing is the point worth carrying: most previous trial effort went into placental transfusion strategies at birth rather than into blood conservation during the days and weeks of neonatal care that follow. Every unit already knows which of its babies are being sampled most, and a strict sampling protocol is the one intervention on that list requiring no device and no purchase.
- Iatrogenic anaemia is a harm of care, not of prematurity
- Six intervention families compared, from cord sampling to strict protocols
- Most prior research addressed birth, not the weeks of sampling after it
- A sampling protocol needs no equipment and no budget line
- Worth auditing your own unit's sampling volume before buying a device
The statistics, in plain English
A systematic review's value lies as much in what it shows is missing as in what it pools. Here the notable gap is that trial effort has concentrated on a single moment — placental transfusion at birth — while the cumulative losses of routine neonatal sampling, which are larger, have been studied far less.
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