Red blood cell transfusion of preterm neonates with a Grade 1 intraventricular hemorrhage is associated with extension to a Grade 3 or 4 hemorrhage

Abstract

An association exists between RBC transfusion and extension of a Grade 1 IVH into a Grade 3 or 4. However, the explanation is unclear and could involve either the reasons transfusion are ordered or the transfusions themselves. Additional studies are needed to discover why neonates are more likely to have IVH extension if transfused.

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

“…More infants in the ESA groups had their iron dose increased on day 14 and day 42 compared 48 (16) 36 (12) 36 (12) .543 Abruption, % (n) 0 9 (3) 18 (6) .039 Previa, % (n)…”

“…However, long-term neurodevelopmental outcomes among those randomized to be liberally transfused were considerably worse. 9,10 Recent studies suggest an association between preterm infant morbidities, such as necrotizing enterocolitis (NEC) and significant intracranial hemorrhage (ICH), with transfusions [11][12][13] ; therefore, using ESAs to avoid these possible risks might prove clinically important.…”

Selection of Therapeutic Tactics for Early Anemia of Premature Infants With Very Low or Extremely Low Birth Weight: Retrospective Study Results

“…Основными причинами развития РАН являются недостаточная продукция эритропоэтина [2], неблаго-приятные факторы анте-и постнатального периода, перинатальные кровопотери и ятрогенные факторы, в частности лабораторная кровопотеря [8][9][10]. Один из наиболее эффективных методов предупреждения развития РАН -профилактика экстремальной недоно-шенности и минимизация числа взятий и объема заби-раемой крови для лабораторных исследований [11,12].…”

Stimulating erythropoiesis in neonates

“…Some of the older concerns over the use of transfusion stemmed from exposure to multiple donors and the potential short-and long-term consequences of this, such as alloimmunization and risk of infectious disease transmission [3]. More recently, both increased risks of significant intracranial hemorrhage (ICH) with early red cell transfusions [6] and necrotizing enterocolitis (NEC; a condition where necrosis of the bowel occurs in neonates) with late transfusions [7] has prompted further concern over this intervention. Furthermore, recent studies suggest that lower hematocrit levels are associated with red cell transfusion-associated NEC [8], which has been suggested to occur since anemia could compromise mucosal integrity and lead to poor wound healing [9].…”

“…It should be noted that there is some controversy about the meta-analyses that have shown an increased risk of ROP and there may have been misclassification of certain studies involved [13]. Given these controversies and the recently recognized additional risks of red cell transfusions in neonates [6,7], there has been a resurgent interest in whether erythropoiesis stimulating agents like Epo may have clinical benefit in neonates.…”