Transfusions with higher red blood cell levels will not improve preterm infant outcomes

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 donating a higher threshold of red blood cells within clinically accepted boundaries (i.e., using a higher level of red blood cells when not which they prescribe referral) any benefit in surviving or reducing brain impairment over a lower level. threshold.

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. Watch a short video of the results here.

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 produced in 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 impairment. neurodevelopmental.

“It is likely that the findings will be used to guide the future use of transition 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 health. of those fragile babies, “Higgins explained.

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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.

This study was supported by grants from the National Institute of Heart, Lung and Blood to Drs. Kirpalani, Bell and Das; and by the NICHD to Neonatal Research Network site researchers. The National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institute of Heart, Lung and Blood (NHLBI), the National Center for Research Resources (NCRR), and an The National Center for the Advancement of Translational Sciences (NCATS) provided grant support for the Neonatal Research Network’s Transfusion of Preemies (TOP) trial through collaborative agreements.

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