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The effect of blood transfusion protocol on retinopathy of prematurity: A prospective, randomized study
S E Brooks1, D M Marcus, D Gillis
1Department of Ophthalmology, Medical College of Georgia, Augusta, Georgia 30912, USA. sbrooks@mail.mcg.edu
Insights
A restrictive red blood cell transfusion protocol for premature infants does not significantly alter the risk of retinopathy of prematurity (ROP) compared to a liberal approach. This finding suggests transfusion policies have minimal impact on ROP incidence and severity.
Area of Science:
- Neonatal Medicine
- Pediatric Ophthalmology
- Hematology
Background:
- Anemia and red blood cell transfusions are common in premature infants.
- The impact of transfusion protocols on retinopathy of prematurity (ROP) remains controversial.
- High-risk premature infants require careful management to prevent ROP.
Purpose of the Study:
- To investigate the influence of different red blood cell transfusion protocols on ROP incidence and severity.
- To compare a symptom-based transfusion guideline with a liberal hematocrit-maintaining strategy.
- To assess associated morbidities and laboratory values in premature infants.
Main Methods:
- A prospective, randomized, masked trial involving 50 infants with birth weights <1251 g.
- Two groups were established: Group 1 (symptom-based transfusions) and Group 2 (hematocrit >40% for 6 weeks).
- Infants were monitored for ROP, growth, morbidity, and serial laboratory values.
Main Results:
- ROP occurred in 83% of Group 1 and 73% of Group 2 infants, with no significant difference in severity.
- No significant differences were observed in ROP, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis between groups.
- No association was found between hemoglobin/hematocrit ratios and ROP incidence or severity.
Conclusions:
- A restrictive, symptom-based red blood cell transfusion policy does not significantly increase ROP risk compared to a liberal policy.
- Transfusion strategies during the neonatal period appear to have a limited impact on ROP development.
- Current transfusion protocols do not differentially affect ROP or other major neonatal morbidities.
Objective:
Controversy exists regarding the potential influence of anemia and blood transfusions on the rate of retinopathy of prematurity (ROP) in premature infants. A prospective, randomized, masked trial was performed to determine the influence of red blood cell transfusion protocol on ROP incidence and severity in a population of high-risk infants.
Methods:
A total of 50 infants with birth weights <1251 g were divided randomly into two groups beginning on day of life 29. Group 1 (n = 24) received red cell transfusions during the 6-week study period, only if certain symptom-based guidelines were met. Group 2 (n = 26) received red cell transfusions to maintain the hematocrit level above 40% for the entire 6 weeks. Infants were monitored for ROP, growth, and associated morbidity. Serial measurements of serum glucose, lactate, ferritin, total iron-binding capacity, and iron were performed.
Results:
ROP occurred in 83% of infants in group 1, and 73% of infants in group 2. There were no statistically significant differences in ROP severity, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, or any of the laboratory values except hemoglobin (10.8 vs 13.2 g/dL) and hematocrit (33.9% vs 41.8%) between the groups. Combining data from both groups, there was no association between hemoglobin or hematocrit ratios and ROP incidence or severity.
Conclusions:
A transfusion policy aimed at limiting the amount of blood given to premature infants (symptom-based) during the neonatal period does not impart a significantly different risk for ROP or other associated conditions, than does a policy in which transfusions are given more liberally for replacement purposes.