Outcomes after implementing restrictive blood transfusion criteria in extremely premature infants

Daniel Knee, Serena Knoop, Alan T Davis, Brenda Rawson, Anna DiCarlo, Rosemary Olivero
Journal of Perinatology: Official Journal of the California Perinatal Association 2019, 39 (8): 1089-1097

OBJECTIVE: To assess mortality and morbidities in very low birthweight (VLBW) infants before and after changing to a restrictive blood transfusion guideline (RTG).

STUDY DESIGN: This is a large retrospective study comparing outcomes of a liberal transfusion guideline (LTG) and RTG in VLBW infants admitted to a large single neonatal intensive care unit. Blood and platelet transfusion details, mortality, and diagnoses of frequently diagnosed morbidities were collected for each infant.

RESULTS: Mortality was similar between RTG and LTG groups (6.8% vs. 6.3%, p = 0.755). Rates of periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), sepsis and the diagnosis of necrotizing enterocolitis (NEC) within 48 h of a PRBC transfusion were significantly lower with RTG (p < 0.05). Chronic lung disease was similar between groups.

CONCLUSION: RTG are safe compared to LTG, and are associated with lower rates of PVL, ROP, transfusion-associated cases of NEC and sepsis.


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