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Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants.

Haresh Kirpalani1, Edward F Bell1, Susan R Hintz1

  • 1From the Department of Pediatrics, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia (H.K., B.S., A.S.C.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., K.J.J., J.A.W.); the Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto (S.R.H., V.Y.C.), and the Department of Pediatrics, University of California, Los Angeles, Los Angeles (U.D.) - both in California; the Biostatistics and Epidemiology Division, RTI International, Research Triangle Park (S.T., M.M.C.), and the Department of Pediatrics, Duke University School of Medicine, Durham (C.M.C.) - both in North Carolina; the Biostatistics and Epidemiology Division, RTI International, Rockville (J.E.N., A.D.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda (R.D.H.) - both in Maryland; the Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI (B.R.V., A.R.L.); the Division of Neonatology, University of Alabama at Birmingham, Birmingham (W.A.C.); the University of Rochester School of Medicine and Dentistry, Rochester, NY (C.T.D., M.F.C.); the Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston (K.A.K.), and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (M.H.W.); the University of New Mexico Health Sciences Center, Albuquerque (R.K.O.); the Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City (R.K.O., B.A.Y.); the Department of Pediatrics, Indiana University School of Medicine, Indianapolis (B.B.P., G.M.S.); Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati (B.B.P., K.S.), the Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland (M.C.W.), and Nationwide Children's Hospital and the Department of Pediatrics, Ohio State University College of Medicine, Columbus (R.S.); the Department of Pediatrics, Dalhousie University, Halifax, NS, Canada (R.K.W.); the Department of Neonatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston (J.A.F.Z.); the Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO (W.E.T.); Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, Wayne State University, Detroit (S.C.); and the College of Health and Human Services, George Mason University, Fairfax, VA (R.D.H.).

The New England Journal of Medicine
|December 31, 2020
PubMed
Summary
This summary is machine-generated.

Higher hemoglobin thresholds for red blood cell transfusions did not improve outcomes in extremely-low-birth-weight infants. This study found no significant difference in survival without neurodevelopmental impairment at 2 years of age.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Hematology
  • Clinical Trials

Background:

  • Anemia is common in extremely-low-birth-weight (ELBW) infants.
  • Previous studies suggested higher hemoglobin thresholds might reduce neurodevelopmental risks.

Purpose of the Study:

  • To determine if a higher hemoglobin threshold for red blood cell transfusions improves outcomes in ELBW infants.
  • To compare survival without neurodevelopmental impairment between higher and lower hemoglobin threshold groups.

Main Methods:

  • An open, multicenter randomized trial involving 1824 ELBW infants (birth weight ≤1000 g, gestational age 22-28 weeks).
  • Infants were assigned to higher or lower hemoglobin transfusion thresholds.
  • Primary outcome: composite of death or neurodevelopmental impairment at 22-26 months corrected age.

Main Results:

  • No significant difference in the primary outcome between higher (50.1%) and lower (49.8%) hemoglobin threshold groups (adjusted RR, 1.00; 95% CI, 0.92-1.10).
  • Similar incidences of death and neurodevelopmental impairment at 2 years between groups.
  • No significant difference in survival without severe complications at discharge.

Conclusions:

  • Higher hemoglobin thresholds for red blood cell transfusions do not improve survival without neurodevelopmental impairment in ELBW infants.
  • The findings do not support the use of higher hemoglobin thresholds to improve neurodevelopmental outcomes in this vulnerable population.