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document
Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants . OBJECTIVE Although many centers have introduced more restrictive transfusion policies for preterm infants in recent years , the benefits and adverse consequences of allowing lower hematocrit levels have not been systematically evaluated . The objective of this study was to determine if restrictive guidelines for red blood cell ( RBC ) transfusions for preterm infants can reduce the number of transfusions without adverse consequences . DESIGN , SETTING , AND PATIENTS We enrolled 100 hospitalized preterm infants with birth weights of 500 to 1300 g into a randomized clinical trial comparing 2 levels of hematocrit threshold for RBC transfusion . INTERVENTION The infants were assigned randomly to either the liberal- or the restrictive-transfusion group . For each group , transfusions were given only when the hematocrit level fell below the assigned value . In each group , the transfusion threshold levels decreased with improving clinical status . MAIN OUTCOME MEASURES We recorded the number of transfusions , the number of donor exposures , and various clinical and physiologic outcomes . RESULTS Infants in the liberal-transfusion group received more RBC transfusions ( 5.2 +/- 4.5 [ mean +/- SD ] vs 3.3 +/- 2.9 in the restrictive-transfusion group ) . However , the number of donors to whom the infants were exposed was not significantly different ( 2.8 +/- 2.5 vs 2.2 +/- 2.0 ) . There was no difference between the groups in the percentage of infants who avoided transfusions altogether ( 12 % in the liberal-transfusion group versus 10 % in the restrictive-transfusion group ) . Infants in the restrictive-transfusion group were more likely to have intraparenchymal brain hemorrhage or periventricular leukomalacia , and they had more frequent episodes of apnea , including both mild and severe episodes . CONCLUSIONS Although both transfusion programs were well tolerated , our finding of more frequent major adverse neurologic events in the restrictive RBC-transfusion group suggests that the practice of restrictive transfusions may be harmful to preterm infants .
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Intervention_Educational
liberal versus restrictive guidelines for red blood cell transfusion
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Intervention_Educational
restrictive guidelines for red blood cell ( RBC ) transfusions
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Intervention_Physical
liberal- or the restrictive-transfusion
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Intervention_Physical
RBC transfusions
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Intervention_Educational
restrictive-transfusion
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Intervention_Physical
transfusion
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Intervention_Physical
restrictive transfusions
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Outcome_Other
number of transfusions
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Outcome_Other
number of transfusions
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Outcome_Other
number of donor exposures
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Outcome_Physical
RBC transfusions
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Outcome_Physical
number of donors
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Outcome_Physical
percentage of infants who avoided transfusions altogether
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Outcome_Physical
intraparenchymal brain hemorrhage or periventricular leukomalacia
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Outcome_Physical
more frequent episodes of apnea
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Outcome_Physical
mild and severe episodes
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Outcome_Adverse-effects
major adverse neurologic events
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Participant_Condition
preterm infants .
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Participant_Condition
100 hospitalized preterm infants with birth weights of 500 to 1300 g