title: Long-term outcome in relationship to neonatal transfusion volume in extremely premature infants: a comparative cohort study.
abstract: BACKGROUND
  In premature born infants red blood cell (RBC) transfusions have been associated with both beneficial and detrimental sequels. Upon RBC transfusion, improvement in cerebral blood flow and oxygenation have been observed, while a more liberal transfusion policy may be associated with a better developmental outcome. The effect of the transfusion volume on long-term outcome is not known.
  
  
  METHODS
  Observational follow-up study of a cohort of extremely premature born infants, treated in 2 neonatal intensive care units using a different transfusion volume (15 ml/kg in Unit A and 20 ml/kg in Unit B). The primary outcome was a composite of post discharge mortality, neuromotor developmental delay, blindness or deafness, evaluated at a mean corrected age (CA) of 24 months related to the transfusion volume/kg bodyweight administered during the postnatal hospital stay.
  
  
  RESULTS
  Despite the difference in transfusion volume in clinically comparable groups of infants, they received a similar number of transfusions (5.5 ± 3.2 versus 5.5 ± 2.3 respectively in Unit A and B). The total transfused volume in unit A was 79 ± 47 ml/kg and 108 ± 47 ml/kg in unit B (p = 0.02). Total transfused RBC volume per kg bodyweight was not an independent predictor of the composite outcome (p = 0.96, OR 1.0 (CI 0.9-1.1).
  
  
  CONCLUSIONS
  There was no relationship between the composite outcome at 24 months CA and transfusion volume received during the post natal hospital stay. As there was no clinical advantage of the higher transfusion volume, a more restrictive volume will reduce total transfusion volume and donor exposure. Future research on the optimal transfusion volume per event to extreme preterm infants should include larger, prospective studies with a longer follow-up period through to childhood or even adolescence.
authors: Division of Neonatology J6-S, Department of Pediatrics, Leiden University Medical Center, 2300RC Leiden, the Netherlands. j.s.von_lindern@lumc.nl
authors: Jeannette S
authors: JS
authors: von Lindern
authors: Chantal M
authors: CM
authors: Khodabux
authors: Karien E A
authors: KE
authors: Hack
authors: Ingrid C
authors: IC
authors: van Haastert
authors: Corine
authors: C
authors: Koopman-Esseboom
authors: Paul H T
authors: PH
authors: van Zwieten
authors: Anneke
authors: A
authors: Brand
authors: Frans J
authors: FJ
authors: Walther
references: Pediatrics. 1981 Dec;68(6):770-4
references: 6895663
references: Arch Dis Child Fetal Neonatal Ed. 2001 May;84(3):F188-93
references: 11320046
references: Pediatrics. 2009 Jan;123(1):207-13
references: 19117884
references: Pediatr Neonatol. 2009 Jun;50(3):110-6
references: 19579757
references: Pediatrics. 2005 Dec;116(6):1353-60
references: 16322158
references: J Perinatol. 2010 Jan;30(1):11-6
references: 19847185
references: Transfusion. 2010 Jun;50(6):1220-6
references: 20113454
references: Pediatrics. 2005 Jun;115(6):1685-91
references: 15930233
references: Arch Pediatr Adolesc Med. 2011 May;165(5):443-50
references: 21199970
references: Pediatrics. 1999 Sep;104(3 Pt 1):514-8
references: 10469778
references: Early Hum Dev. 1993 Sep;34(1-2):47-57
references: 8275882
references: J Pediatr. 2006 Sep;149(3):301-307
references: 16939737
references: Vox Sang. 2009 Jan;96(1):62-85
references: 19121200
references: Arch Ophthalmol. 2005 Jul;123(7):991-9
references: 16009843
references: Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F214-9
references: 9713035
references: Transfus Med. 2009 Aug;19(4):195-201
references: 19706136
references: Med Hypotheses. 2006;66(2):355-64
references: 16236459
references: Early Hum Dev. 2001 Apr;62(1):57-63
references: 11245995
references: Eur J Pediatr. 1997 Jan;156(1):47-50
references: 9007491
references: J AAPOS. 2006 Oct;10(5):449-53
references: 17070481