Very low birth weight babies are at high risk for anemia and often need blood thinners to survive. Some doctors use a higher rate and some use a lower level of red blood cells to order a transplant.
A study supported by the National Institutes of Health suggests that the provision of a higher threshold of red cells is not within clinically accepted boundaries (i.e., using a higher level of red blood cells when they prescribe transmission) any benefit in surviving or reducing brain weakening above a threshold level.
This large, multicenter randomized clinical trial was conducted by Dr. Haresh Kirpalani of the University of Pennsylvania, Dr. Edward Bell of the University of Iowa, and colleagues at the Neonatal Research Network include Dr. Rosemary Higgins of George Mason University College Health and Human Services, former Project Specialist at Network Neonatal Research.
The study appears in New England Journal of Medicine and the largest study to date is to compare thresholds for blood tolerance in premature infants.
True preterm babies (born before 29 weeks gestation) and those weighing less than 1,000 grams (just over 2 pounds) are at high risk for anemia due to their early stage of development, less potential to produce red blood cells, and need blood sampling as part of their intensive medical care.
Previous studies suggest that anemic infants who received transfusions would have a lower risk of death or developmental complications at a higher hemoglobin threshold within the currently accepted range. Measuring hemoglobin, a protein secreted by red blood cells, indicates the proportion of red blood cells. Hemoglobin transfer thresholds for preterm infants vary according to weight, stage of maturity and other factors.
Out of 845 infants assigned to a higher hemoglobin threshold, 50.1% died or survived neurodevelopmental impairment, compared with 49.8% of 847 infants assigned to a lower threshold. When the two complementary outcomes were evaluated separately, both groups had similar mortality rates (16.2% vs. 15%) and neurodevelopmental impairment (39.6% vs. 40.3%).
The authors evaluated the infants at two years of age and conclude that a higher hemoglobin threshold increased the number of sufferers, but did not improve the chance of survival. without neurodevelopmental impairment.
The findings are likely to be used to guide future referral practice for these children; studies in premature babies are needed to guide care for these vulnerable small babies; NIH-funded studies in multisite networks are critical to the health of these vulnerable babies. “
Dr Rosemary Higgins, College of Health and Human Services, George Mason University
The infants in this study are currently seen at five years of age for follow-up assessment to study for long-term differences in the groups with higher and lower thresholds.
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Magazine Reference:
Kirpalani, H., et al. (2020) Higher or lower hemoglobin transfer rates for preterm infants. New England Journal of Medicine. doi.org/10.1056/NEJMoa2020248.