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Meta-Analysis
. 2021 Aug 30;16(8):e0256810.
doi: 10.1371/journal.pone.0256810. eCollection 2021.

Restrictive versus liberal transfusion thresholds in very low birth weight infants: A systematic review with meta-analysis

Peng Wang  1 , Xing Wang  1 , Haidong Deng  2 , Linjie Li  1 , Weelic Chong  3 , Yang Hai  4 , Yu Zhang  1   2
Affiliations
Meta-Analysis

Restrictive versus liberal transfusion thresholds in very low birth weight infants: A systematic review with meta-analysis

Peng Wang et al. PLoS One. .

Abstract

Background: To assess the efficacy and safety of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants.

Methods: We searched MEDLINE, EMBASE, and Cochrane database without any language restrictions. The last search was conducted in August 15, 2020. All randomized controlled trials comparing the use of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight (VLBW) infants were selected. Pooled risk ratio (RR) for dichotomous variable with 95% confidence intervals were assessed by a random-effects model. The primary outcome was all-cause mortality.

Results: Overall, this meta-analysis included 6 randomized controlled trials comprising 3,483 participants. Restrictive transfusion does not increase the risk of all-cause mortality (RR, 0.99; 95% CI, 0.84 to 1.17; I2 = 0%; high-quality evidence), and does not increase the composite outcome of death or neurodevelopmental impairment (RR, 1.01, 95% CI, 0.93-1.09; I2 = 7%; high-quality evidence) or other serious adverse events. Results were similar in subgroup analyses of all-cause mortality by weight of infants, gestational age, male infants, and transfusion volume.

Conclusions: In very low birth weight infants, a restrictive threshold for red blood cell transfusion was not associated with increased risk of all-cause mortality, in either short term or long term.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow chart of the studies recruited in this meta-analysis.
Fig 2
Fig 2
(A) Forest plot comparing overall mortality between restrictive and liberal RBC transfusion thresholds for VLBW infants. (B) Forest plot comparing long-term mortality between restrictive and liberal RBC transfusion thresholds. (C) Forest plot comparing short-term mortality between restrictive and liberal RBC transfusion thresholds. RBC: Red blood cell; VLBW: Very low birth weight.
Fig 3
Fig 3. Subgroup analysis for all-cause mortality.
VLBW: Very low birth weight; ELBW: Extremely low birth weight.
Fig 4
Fig 4
Fig 5
Fig 5. Forest plot comparing the composite death and neurodevelopmental impairment between restrictive and liberal RBC transfusion for VLBW infants.
RBC: Red blood cell; VLBW: Very low birth weight.
See this image and copyright information in PMC

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