NEJM: High hemoglobin blood transfusion less benefits for preterm infants

NEJM: A large-scale study confirms that high hemoglobin blood transfusion has no more benefits for preterm infants. This is the largest study to date comparing the blood transfusion threshold of preterm infants.

Babies with a very low birth weight are at high risk of anemia and often require blood transfusions to survive. When performing blood transfusions, some doctors use a higher hemoglobin threshold, while others use a lower hemoglobin threshold. Some previous studies have suggested that a higher hemoglobin threshold during red blood cell transfusion can reduce the risk of cognitive delay in anemic infants with very low birth weight.

Recently, researchers from the University of Pennsylvania, the University of Iowa and other units have jointly published a paper entitled Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants in the New England Journal of Medicine NEJM.

This is the largest study to date to compare blood transfusion thresholds for preterm infants. This large, multi-center randomized clinical trial showed that the application of high hemoglobin threshold did not improve the blood transfusion threshold for very low birth weight infants in 22 to 26 Survival rate without neurodevelopmental impairment at age.

In this open multi-center randomized trial, the research team recruited 1824 premature babies with a birth weight of 1 kg or less and a gestational age between 22 weeks, 0 days and 28 weeks, 6 days, and randomized them within 48 hours after delivery They are divided into groups and receive red blood cell transfusions with higher or lower hemoglobin thresholds until 36 weeks of gestational age or discharge, whichever comes first. The main outcome is the combined outcome of death or neurodevelopmental impairment (cognitive delay, cerebral palsy, or hearing or vision loss) in the infant from 22 to 26 months of age.

There was a 1.9g/dL difference between the two groups in terms of the average pre-transfusion hemoglobin level throughout the treatment period. This trial obtained primary outcome data for 1692 infants (92.8%). Among the 845 infants in the higher threshold group, 423 (50.1%) died or survived but had neurodevelopmental disorders, while in the lower threshold group 422 (49.8%) died or survived but had neurodevelopmental disorders obstacle.

At 2 years of age, the mortality rate (16.2% and 15.0%, respectively) and the incidence of neurodevelopmental disorders (39.6% and 40.3%, respectively) in the higher and lower threshold groups were similar.

At discharge, the survival rates without severe complications in the two groups were 28.5% and 30.9%, respectively. The incidence of serious adverse events was 22.7% and 21.7%, respectively.

The results of these trials showed that the application of a higher hemoglobin threshold during the transfusion of red blood cells to very low birth weight infants did not improve survival without neurodevelopmental impairment at 22 to 26 months of age.

Premature babies are very light, often fragile and prone to anemia. This study provides guidance for the blood transfusion treatment of these fragile premature babies.

(sourceinternet, reference only)

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