Society for the Advancement of Patient Blood Management: Pediatric and Neonatal Medicine

View all recommendations from this society

September 22, 2021

Don’t proceed with non-emergent major surgery until anemia is evaluated and treated.

Anemia is a global health problem with an incidence of up to 25% in neonates, infants and children. An independent association between preoperative anemia and postoperative morbidity and mortality has been reported. Expert consensus guidelines recommend screening 3 to 6 weeks before majo elective surgery. Targeted preventative and therapeutic strategies, which may include iron supplementation, to improve the hematologic status of anemic patients prior to surgery could reduce blood transfusions, improve safety, and decrease costs.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Patient Blood Management (SABM) had a strong desire to participate in the Choosing Wisely® campaign. Participation allows SABM to align with the national Choosing Wisely® team and other specialty societies to further the mission of collaborative physician-patient healthcare delivery and responsible use of resources.

A Task Force composed of specialists in neonatal and pediatric medicine and surgery was appointed at the suggestion of the SABM Educational Oversight Committee. With SABM BOD approval, this Task Force drafted an initial set of statements. Evidence-based recommendations were based on our Society’s foundational pillars and structured around published SABM Standards. For this particular list, the SABM Standards, Section 13, 5th edition for neonatal and pediatric patients were critical for statement development. An essential element was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were vetted by the Task Force. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The Educational Oversight Committee and the BOD approved the materials prior to submission to the Choosing Wisely® national team.

Working with this initiative, our selected recommendations and integrated materials will be further honed based on subsequent Campaign review. The list and supporting evidence, once approved, will form the basis of a manuscript for publication in a peer-reviewed journal. We foresee this as a vehicle for outreach to other professional societies, healthcare providers and patients.


World Health Organization (WHO) 63rd World Health Assembly. Worldwide prevalence of anemia. 1993-2005. Goobie SM, Faraoni D, Zurakowski D, DiNardo JA. Association of Preoperative Anemia With Postoperative Mortality in Neonates. JAMA Pediatr. 2016 Sep 1;170(9):855-62

Faraoni D, DiNardo JA, Goobie SM. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery. Anesth Analg. 2016 Dec;123(6):1582-1587

Australian guidelines ESA Management of severe Perioperative bleeding Eur J Anaesthesiol 2017 Goobie SM, Gallagher T, Gross I, Shander A. Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version) .Paediatr Anaesth. 2019 Mar;29(3):231-236