Blood Transfusion for Premature Babies: A New Perspective

The largest randomized clinical trial on blood transfusion to premature babies was completed by Dr. Haresh Kirpalani of the University of Pennsylvania, Dr. Edward Bell of the University of Iowa, and colleagues from the Neonatal Research Network, including Dr. Rosemary Higgins of the George Mason University College of Health and Human Services. The study was published in the New England Journal of Medicine. To date, this is the most ambitious research in the world that examines blood transfusion in premature babies.


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When do babies need blood transfusions?

Severely premature babies (born before 29 weeks of gestation) and those weighing 1–2 pounds or less are at high risk of developing anemia due to a reduced ability to produce red blood cells. This can even be fatal. Previous studies have shown that anemic children who received transfusions with a higher hemoglobin threshold were more likely to survive. According to statistics, premature babies are more likely to suffer from neurological disorders, but this was not associated with transfusion of blood oversaturated with erythrocytes.

Evidence base

Of the 845 infants who received high hemoglobin blood transfusions, 50.1 % died or survived with neurodevelopmental disabilities compared with 49.8 % of the 847 infants who received regular blood. The authors assessed the physical and mental development of children at the age of two and came to the conclusion that the number of red blood cells in the transfused blood does not affect mortality rate, and that transfusion of standard blood is safer for neurological development.

“The findings are likely to be used to guide the practice of blood transfusions in infants. Using RBC oversaturated blood was costly and difficult, and while we proved that it not only makes little sense, it can also be harmful," said Dr. Higgins. He went on to say that, “We will continue our research in the hope that we will find a way to increase the survival rate of children born with a weight of 1–2 pounds and below.”

New England Journal of Medicine, www.nejm.org/doi/10.1056/NEJMoa2020248 https://www.clinicaltrials.gov/ct2/show/NCT01702805

08 July 2021

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