title: Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial.
abstract: BACKGROUND
  Even though red blood cells (RBCs) are lifesaving in neonatal intensive care, transfusing older RBCs may result in higher rates of organ dysfunction, nosocomial infection, and length of hospital stay.
  
  
  OBJECTIVE
  To determine if RBCs stored for 7 days or less compared with usual standards decreased rates of major nosocomial infection and organ dysfunction in neonatal intensive care unit patients requiring at least 1 RBC transfusion.
  
  
  METHODS
  Double-blind, randomized controlled trial in 377 premature infants with birth weights less than 1250 g admitted to 6 Canadian tertiary neonatal intensive care units between May 2006 and June 2011.
  
  
  METHODS
  Patients were randomly assigned to receive transfusion of RBCs stored 7 days or less (n = 188) vs standard-issue RBCs in accordance with standard blood bank practice (n = 189).
  
  
  METHODS
  The primary outcome was a composite measure of major neonatal morbidities, including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia, and intraventricular hemorrhage, as well as death. The primary outcome was measured within the entire period of neonatal intensive care unit stay up to 90 days after randomization. The rate of nosocomial infection was a secondary outcome.
  
  
  RESULTS
  The mean age of transfused blood was 5.1 (SD, 2.0) days in the fresh RBC group and 14.6 (SD, 8.3) days in the standard group. Among neonates in the fresh RBC group, 99 (52.7%) had the primary outcome compared with 100 (52.9%) in the standard RBC group (relative risk, 1.00; 95% CI, 0.82-1.21). The rate of clinically suspected infection in the fresh RBC group was 77.7% (n = 146) compared with 77.2% (n = 146) in the standard RBC group (relative risk, 1.01; 95% CI, 0.90-1.12), and the rate of positive cultures was 67.5% (n = 127) in the fresh RBC group compared with 64.0% (n = 121) in the standard RBC group (relative risk, 1.06; 95% CI, 0.91-1.22).
  
  
  CONCLUSIONS
  In this trial, the use of fresh RBCs compared with standard blood bank practice did not improve outcomes in premature, very low-birth-weight infants requiring a transfusion.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00326924; Current Controlled Trials Identifier: ISRCTN65939658.
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. dafergusson@ohri.ca
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
authors.forename: Paul
authors.initials: P
authors.lastname: Hébert
authors.forename: Debora L
authors.initials: DL
authors.lastname: Hogan
authors.forename: Louise
authors.initials: L
authors.lastname: LeBel
authors.forename: Nicole
authors.initials: N
authors.lastname: Rouvinez-Bouali
authors.forename: John A
authors.initials: JA
authors.lastname: Smyth
authors.forename: Koravangattu
authors.initials: K
authors.lastname: Sankaran
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.forename: Morris A
authors.initials: MA
authors.lastname: Blajchman
authors.forename: Lajos
authors.initials: L
authors.lastname: Kovacs
authors.forename: Christian
authors.initials: C
authors.lastname: Lachance
authors.forename: Shoo
authors.initials: S
authors.lastname: Lee
authors.forename: C Robin
authors.initials: CR
authors.lastname: Walker
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.forename: Robin
authors.initials: R
authors.lastname: Ducharme
authors.forename: Katelyn
authors.initials: K
authors.lastname: Balchin
authors.forename: Tim
authors.initials: T
authors.lastname: Ramsay
authors.forename: Jason C
authors.initials: JC
authors.lastname: Ford
authors.forename: Ashok
authors.initials: A
authors.lastname: Kakadekar
authors.forename: Kuppuchipalayam
authors.initials: K
authors.lastname: Ramesh
authors.forename: Stan
authors.initials: S
authors.lastname: Shapiro
mesh_terms: D001724:Birth Weight; D001771:Blood Banks / Q000592:standards; D001997:Bronchopulmonary Dysplasia; D004311:Double-Blind Method; D020345:Enterocolitis, Necrotizing; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D020300:Intracranial Hemorrhages; D008297:Male; D009017:Morbidity; D012178:Retinopathy of Prematurity; D016896:Treatment Outcome