Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants

Whyte, Robin; Kirpalani, Haresh

doi:10.1002/14651858.cd000512.pub2

Cited by 130 publications

(147 citation statements)

References 68 publications

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“…Although our meta-analysis includes additional recently available studies, the findings are similar to previously published Cochrane reviews. [100][101][102] There is very little literature published on reducing the risk of infection in preterm neonates and its effect on the incidence of ROP. Although there are single studies of interventions to prevent infection that also report ROP outcomes, [103][104][105] only those studying fluconazole prophylaxis had sufficient numbers for quantitative analysis.…”

Section: Tablementioning

confidence: 99%

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang¹,

Sorita²,

Carey³

et al. 2016

Pediatrics

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CONTEXT: The effectiveness of many interventions aimed at reducing the risk of retinopathy has not been well established. OBJECTIVE:To estimate the effectiveness of nutritional interventions, oxygen saturation targeting, blood transfusion management, and infection prevention on the incidence of retinopathy of prematurity (ROP). DATA SOURCES:A comprehensive search of several databases was conducted, including Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through March 2014. STUDY SELECTION:We included studies that evaluated nutritional interventions, management of supplemental oxygen, blood transfusions, or infection reduction and reported the incidence of ROP and mortality in neonates born at <32 weeks. DATA EXTRACTION:We extracted patient characteristics, interventions, and risk of bias indicators. Outcomes of interest were any stage ROP, severe ROP or ROP requiring treatment, and mortality. RESULTS:We identified 67 studies enrolling 21 819 infants. Lower oxygen saturation targets reduced the risk of developing any stage ROP (relative risk [RR] 0.86, 95% confidence interval [CI], 0.77-0.97) and severe ROP or ROP requiring intervention (RR 0.58, 95% CI, 0.45-0.74) but increased mortality (RR 1.15, 95% CI, 1.04-1.29). Aggressive parenteral nutrition reduced the risk of any stage ROP but not severe ROP. Supplementation of vitamin A, E, or inositol and breast milk feeding were beneficial but only in observational studies. Use of transfusion guidelines, erythropoietin, and antifungal agents were not beneficial. LIMITATIONS:Results of observational studies were not replicated in randomized trials. Interventions were heterogeneous across studies. CONCLUSIONS:At the present time, there are no safe interventions supported with high quality evidence to prevent severe ROP.

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Section: Tablementioning

confidence: 99%

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang¹,

Sorita²,

Carey³

et al. 2016

Pediatrics

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“…There were no statistically significant differences in the combined outcomes of death or serious morbidity at first hospital discharge. [5] This review, coupled with our drive to adopt cost-effective evidence-based guidelines in our unit, resulted in the introduction of a restrictive BTF policy. The adoption of this protocol was consensus driven and had unanimous 'buy in' from all senior clinicians in the unit.…”

Section: Discussionmentioning

confidence: 99%

Resource implications of adopting a restrictive neonatal blood transfusion policy

et al. 2013

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“…The current recommendations are based on a small number of randomized trials. The 2 largest trials (Premature Infants in Need of Transfusion, 24 Bell et al 25 ) remain the basis of current transfusion practice. Both trials randomized high-risk preterm infants to either a liberal or restricted transfusion schedule.…”

Section: Co and Changes In Systemic Hemodynamics After Deliverymentioning

confidence: 99%

“…Meta-analyses concluded no clear benefit for either liberal or restrictive transfusion thresholds in very low birth weight newborns, although more longterm data were recommended. 24 Additional large trials using similar methodology are currently recruiting. 26,27 Although the model of transfusion practice using predefined Hb or hematocrit thresholds is easy to understand, it is inconsistent with overall oxygen physiology.…”

Section: Whereas the Premature Infants Inmentioning

confidence: 99%

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

et al. 2017

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John Scott Haldane recognized that the administration of supplemental oxygen required titration in the individual. Although he made this observation in adults, it is equally applicable to the preterm newborn. But how, in practice, can the oxygen requirements in the preterm newborn be determined to avoid the consequences of too little and too much oxygen? Unfortunately, the current generation of oxygen saturation trials in preterm newborns guides saturation thresholds rather than individual oxygen requirements. For this reason, we propose an alternate model for the description of oxygen sufficiency. This model considers the adequacy of oxygen delivery relative to simultaneous consumption. We describe how measuring oxygen extraction or the venous oxygen reservoir could define a physiologically based definition of adequate oxygen. This definition would provide a clinically useful reference value while making irrelevant the absolute values of both oxygen delivery and consumption. Additional trials to test adjunctive, noninvasive measurements of oxygen status in high-risk preterm newborns are needed to minimize the effects of both insufficient and excessive oxygen exposure.

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Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants

Abstract: Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants (Review)

Cited by 130 publications

References 68 publications

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Resource implications of adopting a restrictive neonatal blood transfusion policy

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

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