What Is New about Transfusions for Preterm Infants? An Update

Abstract

Currently the question of whether to maintain a higher hemoglobin level by transfusing more liberally, as opposed to a more restrictive strategy with lower hemoglobin maintenance levels, has not been answered. We review summarized conclusions of a Cochrane systematic review and meta-analysis of 614 infants in 4 randomized controlled trials (RCT) pooling data. This suggests potential benefits of higher hemoglobin levels, i.e., a possible improved cognition of infants at 18–21 months’ corrected age and a reduction of apnea. However, the data on cognition is hypothesis generating as it derives from a post hoc analysis from a single trial in 451 infants. Moreover, the data on apnea need confirmation in larger trials. The effect of adding data of cognitive 2-year outcomes of 1,744 infants from 2 RCT, which will be reported soon, should expand our understanding. This new data will need to be integrated with the older generation of RCTs but also with emerging suggestions from observational data on potential risks of blood transfusions. We discuss some of these warnings from observational studies. Finally, we ask whether we are ready to individualize blood transfusion to physiological measures made in individual infants, and we point to some current difficulties hindering this step.

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

“…Transfusion thresholds remain controversial as RBC transfusions are associated with increased risk for ischemia-reperfusion damage or oxidative injury potentially resulting in transfusion-associated necrotizing enterocolitis, bronchopulmonary dysplasia and retinopathy of prematurity (1,16). Several studies comparing high (liberal) and low (restrictive) Hb or Ht thresholds for RBC transfusion have been published (17)(18)(19)(20), but controversies about when to transfuse anemic preterm infants still remain (21)(22)(23).…”

Prematürede anemi ve transfüzyon politikaları

“…Kirpalani ve Whyte [22] ise 2019 yılında prematüre bebeklerde eritrosit transfüzyon kararı için kapiller Hb ve Htc değerlerini içeren bir tablo yayınlamışlardır (Tablo 4). Bu tabloyla kıyaslandığında; TND 2021 eritrosit transfüzyon rehberi güncellemesinin solunum desteği gereken grupta genel olarak benzer olduğu, ancak solunum desteği almayan grupta 2. haftadan sonra ortalama 0,5 g/dL daha düşük olduğu görülmektedir.…”