A collaborative group of researchers, led by Children's Hospital of Philadelphia (CHOP), found that a higher hemoglobin threshold for red blood cell transfusions in anemic, extremely-low-birth-weight newborns does not improve survival or reduce neurodevelopmental impairment by age 2. The study, which is the largest on this topic to date, was recently published in the New England Journal of Medicine.
In a randomized controlled trial, the researchers analyzed 1,824 infants between 22 and 29 weeks of age who weighed less than 1,000 grams at birth. The infants were randomly assigned to one of two groups: one that would receive higher red blood cell transfusions and one that would receive lower red blood cell transfusions. They followed both groups until they were about 2 years old and monitored for death or neurodevelopmental impairment, such as cognitive delay, cerebral palsy, and hearing or vision loss.
In comparing the two groups, the researchers found no statistically significant difference in outcomes. The higher and lower hemoglobin threshold groups had similar rates of death, neurodevelopmental impairments, and serious adverse events.
"The results of this trial support the notion that we can use less blood when transfusing very low birth weight babies," said Haresh M. Kirpalani, MD, Professor Emeritus of neonatology at CHOP and Principal Investigator. "Given the potential hazards associated with blood transfusions in an already vulnerable population, these data support the notion that less is more, and we should not be transfusing infants unnecessarily. This also shows how therapies commonly thought of as 'standard care' may require further testing to assess their true value."
