Babies who are very low birth weight often need blood transfusions to survive. A study funded by the National Institutes of Health suggests that providing a higher threshold of red blood cells within accepted limits offers no advantage in surviving or reducing neurological damage above a lower threshold.
The research was conducted by Haresh Kirpalani, WB, of the University of Pennsylvania, Philadelphia, and colleagues and was funded by the National Institute of Child Health and Human Development (NICHD), NIH’s National Institute of Heart, Lung and Blood. . and the National Center for the Advancement of Translational Sciences. The study appears in The New England Journal of Medicine.
Very premature babies (born before 29 weeks of pregnancy) and those who weigh less than 1,000 grams (just over 2 kilograms) have an increased risk of anemia due to their early stage of development, reduced ability to produce cells. Red blood cells and the need for increased blood sampling as part of their intensive medical care. Previous studies suggest that anemic infants would have a lower risk of death, cognitive retardation, cerebral palsy and hearing and vision loss if they received transfusions leading to higher hemoglobin thresholds in the currently accepted range. Measurement of hemoglobin, a protein produced in red blood cells, indicates the proportion of red blood cells. Hemoglobin transfusion thresholds in premature infants vary depending on weight, stage of maturity and other factors.
Of the 845 infants assigned to a higher hemoglobin threshold, 50.1% died or survived with insufficient neurodevelopment, compared with 49.8% of 847 infants assigned to a lower threshold. When the two-component outcomes were assessed separately, the two groups also had similar rates of death (16.2% vs. 15%) and neurodevelopmental impairment (39.6% vs. 40.3%). . The authors conclude that a higher hemoglobin threshold increased the number of transfusions, but did not improve the chance of survival without affecting neurodevelopment.