Restrictive versus liberal transfusion thresholds in very low birth weight infants: A systematic review with meta-analysis

Abstract

Background To assess the efficacy and safety of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants. Methods We searched MEDLINE, EMBASE, and Cochrane database without any language restrictions. The last search was conducted in August 15, 2020. All randomized controlled trials comparing the use of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight (VLBW) infants were selected. Pooled risk ratio (RR) for dichotomous variable with 95% confidence intervals were assessed by a random-effects model. The primary outcome was all-cause mortality. Results Overall, this meta-analysis included 6 randomized controlled trials comprising 3,483 participants. Restrictive transfusion does not increase the risk of all-cause mortality (RR, 0.99; 95% CI, 0.84 to 1.17; I2 = 0%; high-quality evidence), and does not increase the composite outcome of death or neurodevelopmental impairment (RR, 1.01, 95% CI, 0.93–1.09; I2 = 7%; high-quality evidence) or other serious adverse events. Results were similar in subgroup analyses of all-cause mortality by weight of infants, gestational age, male infants, and transfusion volume. Conclusions In very low birth weight infants, a restrictive threshold for red blood cell transfusion was not associated with increased risk of all-cause mortality, in either short term or long term.

Immunologic effects of red blood cell and platelet transfusions in neonates

“…Although the data from the initial studies was conflictive [2,3], two larger recently published randomized trials (TOP and ETTNO) found no differences between the liberal and restrictive transfusion groups in the primary outcome of death or neurodevelopmental impairment at 24 months of age [4 ▪▪ ,5 ▪▪ ]. In contrast to prior observational studies, which had reported an association between RBC transfusions and both bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) (diseases of prematurity with a strong inflammatory component) [6], none of the randomized trials found increased rates of those or other complications in neonates transfused more liberally [7]. However, the neurodevelopmental outcomes evaluated in the RCTs measured severe deficits, and it remains unclear whether RBC transfusions (or anemia) are associated with more subtle neurodevelopmental problems (i.e.…”

“…]. In contrast to prior observational studies, which had reported an association between RBC transfusions and both bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) (diseases of prematurity with a strong inflammatory component) [6], none of the randomized trials found increased rates of those or other complications in neonates transfused more liberally [7]. However, the neurodevelopmental outcomes evaluated in the RCTs measured severe deficits, and it remains unclear whether RBC transfusions (or anemia) are associated with more subtle neurodevelopmental problems (i.e.…”

Comparative efficacy and safety of restrictive versus liberal transfusion thresholds in anemic preterm infants: a meta-analysis of 12 randomized controlled trials

“…Several meta-analyses [25][26][27][28] have compared the efficacy and safety of restrictive versus liberal transfusion thresholds.…”

“…A series of previous randomized controlled trials (RCTs) have investigated the impact of different transfusion thresholds on clinical outcomes of anemic preterm infants but reported conflicting results [22][23][24]. Subsequently, several meta-analyses [25][26][27][28] have further evaluated the comparative efficacy and safety of restrictive versus liberal transfusion thresholds for treating anemic preterm infants and suggested that restrictive transfusion threshold was comparable to liberal transfusion threshold in death and neurodevelopment. However, the value of these findings dedicated to making the clinical decision was limited because several clinically important outcomes were not evaluated in previous meta-analyses, such as age at first transfusion, total transfusion volume, and time on supplemental oxygen.…”

Prematürede anemi ve transfüzyon politikaları

“…Geçmişte kısıtlı ve liberal transfüzyonla ilgili yapılan en önemli randomize kontrollü iki çalışma IOWA ve PINT çalışmalarıdır [16,25,26] rapor edilmiştir [29]. Mevcut bulgular ışığında ve TND 2021 güncellemesinin de önerisiyle prematüre bebeklerde kısıtlı transfüzyon yaklaşımının uygulanması daha uygun gibi gözükmektedir [16].…”