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This study identifies the benefit of using donor exposure rate (DER) to transfusion rate (TR) ratio as a discriminative index for assessing improvement in practice pattern in multiple-transfused neonates. It provides a methodology to demonstrate reduction in donor exposure that is not evident from the use of DER alone. Two time points, one 12-month period (1996-1997) before and one 12-month period (1999-2000) following the introduction of a paedipack system, were reviewed. Blood issued and wasted was quantified. The 1994 BSCH guidelines to define transfusion were used for both time periods, and recombinant erythropoietin (EPO) was not used. Following implementation of paedipack system, 186 donor units were made into satellite bags and kept for 35 days. A dramatic decrease in DER : TR ratio was noted for 79 transfused infants. The DER : TR ratio was 1 : 1 before and 1 : 3.2 after introduction of paedipacks, giving a 70.5% reduction in donor exposure risk. This was not evident from the use of DER alone, which remained the same (2.4) in the historical and study groups. High transfusions per donor unit (TPDU) correlated with the reduction in DER : TR ratio. Red cell wastage per transfusion was 190 +/- 30 mL before and 24.5 +/- 10 mL after intervention.

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A premature male infant is described in whom the presence of coarse facies, diaphragmatic hernia, genital anomalies and Dandy‐Walker malformation suggested a diagnosis of Fryns' syndrome. Lymphocyte karyotype revealed a partial trisomy 22, and his mother carried an apparently balanced 11/22 translocation. Three infants have been described recently with features of Fryns' syndrome and various aneuploidies. It is suggested that amplified developmental instability of the midline developmental field may account for some of the phenotypic resemblances between these cases.

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