Abstract OBJECTIVE: To evaluate the risks and benefits of two transfusion strategies (liberal-transfusion and restrictive-transfusion), as judged by the clinical progress and outcome, in very low birth weight infants. METHODS: The clinical data of 93 hospitalized very low birth weight infants who required blood transfusions were retrospectively studied. The infants were assigned to either the liberal transfusion group (n=58), with higher hematocrit levels, or the restrictive-transfusion group (n=35), with lower hematocrit levels. RESULTS: The infants in the restrictive-transfusion group received more numbers of RBC transfusions compared with the liberal-transfusion group (2.6±1.8 vs 1.8±1.0; P<0.05). Liberal-transfusion was associated with faster weight gain and the duration to return to the birth weight averaged 10 days in the liberal-transfusion group compared with 13 days in the restrictive-transfusion group (P<0.01). The infants in the liberal-transfusion group had shorter duration of mechanical ventilation than in the restrictive-transfusion group (5.5±4.2 days vs 8.0± 5.9 days; P<0.05). There were no significant differences in the incidence of apnea and nosocomial infections between two groups. CONCLUSIONS: The study suggests the possible benefits from liberal-transfusion for clinical recovery in very low birth weight infants. The restrictive transfusion does not decrease the number of transfusions. It in fact increases the number of clinical indicated transfusions. Neonatologists should weigh the advantages and disadvantages on transfusions to make the optimal decision.[Chin J Contemp Pediatr, 2010, 12 (1):9-12]
SHEN Xiao-Xia,DU Li-Zhong,SHI Li-Ping et al. Comparison of clinical outcomes in very low birth weight infants with anemia by different transfusion strategies[J]. 中国当代儿科杂志, 2010, 12(1): 9-12.
SHEN Xiao-Xia,DU Li-Zhong,SHI Li-Ping et al. Comparison of clinical outcomes in very low birth weight infants with anemia by different transfusion strategies[J]. CJCP, 2010, 12(1): 9-12.
[1]Doctor A, Platt R, Sheram ML, Eischeid A, McMahon T, Maxey T, et al. Hemoglobin conformation couples erythrocyte S-nitrosothiol content to O2 gradients[J].Proc Natl Acad Sci USA, 2005, 102(16):5709-5714.
[2]Alagappan A, Shattuck KE, Malloy MH. Impact of transfusion guide-lines on neonatal transfusions[J]. J Perinatol,1998, 18(2):92-97.
[3]Maier RF, Sonntag J, Walka MM, Liu G, Metze BC, Obladen M. Changing practices of red blood cell transfusions in infants with birth weightess than 1000 g[J]. J Pediatr, 2000,136(2):220-224.
[4]Franz AR, Pohlandt F. Red blood cell transfusions in very and ex-tremely low birthweight infants under restrictive transfusion guidelines: is exogenous erythropoietin necessary?[J]. Arch Dis Child Fetal Neonatal Ed, 2001, 84(2):F96-100.
[5]Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants[J]. Pediatrics,2005,115(6):1685-91.
[7]Christou HA, Shannon K, Rowitch DH.Anemia[M].// Cloherty JP. Manual of Neonatal Care.6th ed. Philadelphia: Nolters, 2008:436-443.
[8]Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, et al. A randomized controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants:the PINT study[J]. J Pediatr, 2006, 149(3):301-307.
[9]Lacroix J, Hébert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, et al. Transfusion strategies for patients in pediatric intensive care units[J].N Engl J Med, 2007, 356(16):1609-1619.
[10]Eyer J, Sive A, Jacobs P. Empiric red cell transfusion in asymptomatic preterm infants[J]. Acta Paediatr, 1993,82(1):30-34.
[11]James L, Greenough A, Naik S. The effect of blood transfusion on oxygenation in premature ventilated neonates[J]. Eur J Pediatr, 1997,156(2):139-141.
[12]Ross MP, Christensen RD, Rothstein G, Koening JM, Simmons MA, Noble NA, et al. A randomized trial to develop criteria for administering erythrocyte transfusions to anemic preterm infants 1 to 3 months of age[J]. J Perinatol, 1989, 9(3):246-253.
[13]Stute H, Greiner B, Linderkamp O. Effect of blood transfusion on cardiorespiratory abnormalities in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 1995, 72(3):F194-F196.
[14]Jonas RA, Wypij D, Roth SJ, Bellinger DC, Visconti KJ, du Plessis AJ, et al. The influence of hemodilution on outcome after hypo-thermic cardiopulmonary bypass: results of a randomized trial in infants[J].J Thorac Cardiovasc Surg, 2003, 126(6):1765-1774.