A very strict guideline reduces the number of erythrocyte transfusions in preterm infants.
OBJECTIVE
Benefits of adopting restrictive guidelines for erythrocyte transfusions are still controversial. The objective of this study was to verify if a very strict guideline could reduce erythrocyte transfusions in preterm infants without adverse outcomes.


METHODS
Two prospective cohorts of neonates with gestational age < 37 weeks and birth weight < 1500 g were studied. Neonates born in Period 1 were submitted to a strict guideline for erythrocyte transfusions. In Period 2, a new stricter protocol was introduced. Infants of both periods were compared regarding number of transfusions and clinical outcome.


RESULTS
The median number of transfusions decreased from 2 (1 to 14) in Period 1 to 1 (1-9), P = 0.001, in Period 2. The linear regression multivariate analysis showed that the implementation of the stricter guideline was associated with a reduction in the number of transfusions received by patients by 0.55 (95% confidence interval: -0.08; -1.02) units/patients. Number of apnea episodes, weight at 28 days of life and days of hospital stay were similar in both periods. Intra-hospital death was lower in Period 2.


CONCLUSIONS
A very strict guideline reduced the number of erythrocyte transfusions in preterm infants, without threatening their clinical course.
Division of Neonatal Medicine, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
A F M A
AF
Mimica
A M N
AM
dos Santos
D H F
DH
da Cunha
R
R
Guinsburg
J O
JO
Bordin
A
A
Chiba
M M O
MM
Barros
B I
BI
Kopelman
D001049:Apnea / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence; D006400:Hematocrit; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology / Q000517:prevention & control; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018962:Phlebotomy / Q000009:adverse effects; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies