Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2005 Jun;115(6):1685-91.
doi: 10.1542/peds.2004-1884.

Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants

Edward F Bell  1 , Ronald G Strauss, John A Widness, Larry T Mahoney, Donald M Mock, Victoria J Seward, Gretchen A Cress, Karen J Johnson, Irma J Kromer, M Bridget Zimmerman
Affiliations
Clinical Trial

Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants

Edward F Bell et al. Pediatrics. 2005 Jun.

Abstract

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.

Design, setting, and patients: 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.

Intervention: 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.

Main outcome measures: 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.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Profile of infant enrollment and participation.
See this image and copyright information in PMC

Comment in

References

    1. Strauss RG. Transfusion therapy in neonates. Am J Dis Child. 1991;145:904–911. - PubMed
    1. Sacher RA, Luban NLC, Strauss RG. Current practice and guidelines for the transfusion of cellular blood components in the newborn. Transfus Med Rev. 1989;3:39–54. - PubMed
    1. Widness JA, Seward VJ, Kromer IJ, Burmeister LF, Bell EF, Strauss RG. Changing patterns of red blood cell transfusion in very low birth weight infants. J Pediatr. 1996;129:680–687. - PubMed
    1. Alagappan A, Shattuck KE, Malloy MH. Impact of transfusion guidelines on neonatal transfusions. J Perinatol. 1998;18:92–97. - PubMed
    1. Maier RF, Sonntag J, Walka MM, Liu G, Metze BC, Obladen M. Changing practices of red blood cell transfusions in infants with birth weight less than 1000 g. J Pediatr. 2000;136:220–224. - PubMed

Publication types

MeSH terms