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Comparative efficacy and safety of restrictive versus liberal transfusion thresholds in anemic preterm infants: a
Xiaoling Fu1, Xingdan Zhao2, Aihan Weng2
1Department of Blood Transfusion, Hainan Women and Children's Medical Center, Haikou, 570000, Hainan Province, China. fuxiaoling88@126.com.
Insights
Liberal transfusion thresholds increase hemoglobin and hematocrit levels in preterm infants. However, restrictive thresholds may lead to longer respiratory support needs, indicating both strategies are effective and safe.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Critical Care
Background:
- Anemia in preterm infants is common, with ongoing debate regarding optimal blood transfusion strategies.
- Comparing restrictive versus liberal transfusion thresholds is crucial for improving infant outcomes.
Approach:
- A meta-analysis of 12 randomized controlled trials (RCTs) involving 4380 preterm infants was conducted.
- Searched major databases (PubMed, Embase, Cochrane Library, CNKI) for relevant RCTs up to April 30, 2022.
- Data extraction and quality appraisal were performed by two independent investigators, with meta-analysis using RevMan 5.3.5.
Key Points:
- Liberal transfusion thresholds significantly increased post-transfusion hemoglobin and hematocrit levels compared to restrictive thresholds.
- Restrictive transfusion was associated with a higher age at first transfusion but also longer durations of supplemental oxygen and ventilator/CPAP support.
- Sensitivity analyses confirmed the robustness of key findings regarding hemoglobin, age at transfusion, respiratory support, and safety outcomes.
Conclusions:
- Both liberal and restrictive transfusion thresholds represent effective and safe strategies for managing anemia in preterm infants.
- Liberal thresholds may offer an advantage in potentially reducing the duration of respiratory support required.
Abstract:
The comparative efficacy and safety of restrictive with liberal transfusion thresholds remain controversial in anemic preterm infants. This meta-analysis aimed to compare the efficacy and safety of these two transfusion thresholds for anemic preterm infants. We searched PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) for relevant randomized controlled trials (RCTs) comparing restrictive with liberal transfusion thresholds in anemic preterm infants through April 30, 2022. Two independent investigators screened literature, extracted data, and appraised the methodological quality of eligible studies. Meta-analysis was conducted using RevMan version 5.3.5. Twelve RCTs with 4380 preterm infants were included. Liberal transfusion threshold significantly increased the level of hemoglobin after transfusion (mean difference (MD): -10.03; 95% confidence interval (CI): -15.98 to -4.08; p=0.001; I2=94%) and hematocrit (MD: -3.62; 95%CI: -6.78 to -0.46; p=0.02; I2=80%) compared with restrictive transfusion. Infants' age at first transfusion in restrictive transfusion group was higher than that of infants in liberal transfusion group (MD: 5.08; 95%CI: 2.27 to7.89; p=0.004; I2=54%); however, restrictive transfusion was associated with more time on supplemental oxygen (MD: 3.56; 95%CI: 1.93 to 5.18; p<0.001; I2=62%) and ventilator or CPAP (MD: 3.31; 95%CI: 1.42 to 5.20; p=0.006; I2=75%). For the remaining outcomes, two transfusion strategies were comparable. Furthermore, a series of sensitivity analyses confirmed the robustness of the level of hemoglobin after transfusion, age at first transfusion, time on ventilator or CPAP, and safety outcomes. Evidence with substantial heterogeneity indicates that liberal and restrictive transfusion thresholds are effective and safe blood cell transfusion strategies in anemic preterm infants, but the liberal strategy may be more effective in shortening the length of necessary respiratory support.
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