This was a long time ago, at a different hospital where we didn't obtain consent before blood transfusions. Now we do and even if consent has been previously obtained I still try to contact the parents to let them know before a transfusion. Blood transfusions aren't that big of a deal to neonatologists. We do them frequently but not carelessly; they are simply part of our therapeutic armamentarium.
For parents, though, blood transfusions can stir an emotional reaction, even if they're not Jehovah's Witnesses. There's something about receiving another person's blood that really bothers some people. Part of it may be a fear of infections like HIV, but I think it's more than that. I think it's a very personal thing, taking another's blood into your own body. I don't understand it completely, but maybe it's sort of like chewing another person's already chewed gum, or licking their ice cream cone.
Over the past several years neonatologists have tended to be more and more conservative with transfusions, letting a baby's hematocrit drop lower and lower before transfusing them. I have done the same thing, although I have to admit that this practice wasn't always necessarily evidence based. In the past year approximately, two studies have examined the issue. One of them, from Iowa, suggests that this lower threshold for transfusing might not be good. The second study, from Canada and just published, suggests the opposite, that transfusing at lower levels is indeed safe.
Oh well, it's not like this is the first time we've had to deal with contradictory evidence in neonatal medicine. I'll keep transfusing when I think it's best, while all the while looking for better evidence to support my practices, and I'll definitely keep notifying parents before I do.