[Protocol - indications for transfusion in newborns with low and extremely low birght weight]

Hyporegenerative anaemia of prematurity is the cause of frequent transfusions of packed red blood cells. Wellknown is the effect of inhibiting the erythropoiesis after blood transfusions as well as the risk of transmissive infections. Therefore the main purpose of this study was to work out a protocol - indications for blood transfusions in order to achieve maximal reduction in their incidence with premature babies during their stay in ICU.

The study includes 57 newborn babies - birth weight < or = 1400 g, gestational age < or = 34 g.w. The changes in blood count values (Hb, Ht, Er,) from day 1 until day 60-70 were followed and analyzed. The effect of blood transfusions on oxygen needs reduction was analyzed by monitoring acid-base status in 30 infants with anaemia of prematurity with different degree of oxygen dependency.

Mean Hb and Ht at birth were 163 +/- 20,4 g/l and 48.6 +/- 6, 3%. At day 15-20 Hb was 111,02 +/- 10,9 and Ht 32,65 +/- 3,46. A significant decrease in blood count values is observed until the end of the first month /p <0.05/. Afterwards they remain relatively constant, fairly close to those at day 25-30/Hb 101,45 +/- 10,24 g/l; Ht% 29,78 +/- 3,42/. The study showed that transfusions of packed red blood cells reduce oxygen requirements by aproximately 30% in premature babies on mechanical ventilation with high oxygen concentrations\FiO2 > or = 50%/. In premature babies with good overall condition and on low concentration oxygen therapy - < 50%, no effect was observed in reducing oxygen requirements after RBC transfusion.

The leading indications for RBC-transfusions are not only Hb, Ht, postnatal age, but also the clinical condition and oxygen requirements. Severely ill premature babies on mechanical ventilation with FiO2 > or = 50% require blood transfusion at higher Hb values/<120 g/l/regardless of postnatal age.