Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants.
OBJECTIVE
Although many centers have introduced more restrictive transfusion policies for preterm infants in recent years, the benefits and adverse consequences of allowing lower hematocrit levels have not been systematically evaluated. The objective of this study was to determine if restrictive guidelines for red blood cell (RBC) transfusions for preterm infants can reduce the number of transfusions without adverse consequences.


METHODS
We enrolled 100 hospitalized preterm infants with birth weights of 500 to 1300 g into a randomized clinical trial comparing 2 levels of hematocrit threshold for RBC transfusion.


METHODS
The infants were assigned randomly to either the liberal- or the restrictive-transfusion group. For each group, transfusions were given only when the hematocrit level fell below the assigned value. In each group, the transfusion threshold levels decreased with improving clinical status.


METHODS
We recorded the number of transfusions, the number of donor exposures, and various clinical and physiologic outcomes.


RESULTS
Infants in the liberal-transfusion group received more RBC transfusions (5.2 +/- 4.5 [mean +/- SD] vs 3.3 +/- 2.9 in the restrictive-transfusion group). However, the number of donors to whom the infants were exposed was not significantly different (2.8 +/- 2.5 vs 2.2 +/- 2.0). There was no difference between the groups in the percentage of infants who avoided transfusions altogether (12% in the liberal-transfusion group versus 10% in the restrictive-transfusion group). Infants in the restrictive-transfusion group were more likely to have intraparenchymal brain hemorrhage or periventricular leukomalacia, and they had more frequent episodes of apnea, including both mild and severe episodes.


CONCLUSIONS
Although both transfusion programs were well tolerated, our finding of more frequent major adverse neurologic events in the restrictive RBC-transfusion group suggests that the practice of restrictive transfusions may be harmful to preterm infants.
Bell
Edward F
EF
Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. edward-bell@uiowa.edu
Strauss
Ronald G
RG
Widness
John A
JA
Mahoney
Larry T
LT
Mock
Donald M
DM
Seward
Victoria J
VJ
Cress
Gretchen A
GA
Johnson
Karen J
KJ
Kromer
Irma J
IJ
Zimmerman
M Bridget
MB
D000740:Anemia / Q000097:blood / Q000628:therapy*; D001049:Apnea / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D001782:Blood Donors; D001925:Brain Damage, Chronic / Q000209:etiology / Q000517:prevention & control; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015897:Comorbidity; D004374:Ductus Arteriosus, Patent / Q000453:epidemiology; D004453:Echoencephalography; D017707:Erythrocyte Transfusion / Q000592:standards* / Q000706:statistics & numerical data; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007902:Length of Stay / Q000706:statistics & numerical data; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D017410:Practice Guidelines as Topic / Q000592:standards; D012178:Retinopathy of Prematurity / Q000453:epidemiology; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome
D010100:Oxygen