Higher Hb Threshold for Transfusion Not Better for Preemies

WEDNESDAY, Jan. 13, 2021 -- Use of a higher hemoglobin transfusion threshold does not lower the risk for death or neurodevelopmental impairment at 22 to 26 months of age among extremely low-birth-weight infants with anemia, according to a study published in the Dec. 31 issue of the New England Journal of Medicine.

Haresh Kirpalani, M.D., from the University of Pennsylvania in Philadelphia, and colleagues conducted a multicenter trial involving infants with a birth weight of 1,000 g or less and a gestational age between 22 weeks zero days and 28 weeks six days. Within 48 hours of delivery, 1,824 infants were randomly assigned to receive red-cell transfusions at either higher or lower hemoglobin thresholds until 36 weeks of postmenstrual age or discharge; primary outcome data were available for 1,692 infants.

Throughout the treatment period, there was a between-group difference of 1.9 g/dL in the pretransfusion mean hemoglobin levels. The researchers found that 50.1 percent of the 845 infants in the higher-threshold group died or survived with neurodevelopmental impairment compared with 49.8 percent of 847 infants in the lower-threshold group (relative risk adjusted for birth-weight stratum and center, 1.00; 95 percent confidence interval, 0.92 to 1.10; P = 0.93). The incidences of death (16.2 and 15.0 percent, respectively) and neurodevelopmental impairment (39.6 and 40.3 percent, respectively) were similar for the higher- and lower-threshold groups at two years.

"These results are consistent with the failure of erythropoietin to improve cognitive or other neurodevelopmental outcomes despite increasing red-cell mass," the authors write.

One author disclosed financial ties to Mednax.

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Posted: January 2021