Neurodevelopmental Outcome of Extremely Low-Birth-Weight Infants Randomly Assigned to Restrictive or Liberal Hemoglobin Thresholds for Blood Transfusion

• Published in: Seminars in perinatology Vol. 36; no. 4; pp. 290 - 293
• Main Author: Whyte, Robin K., MB, FRCP(C)
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2012
• Subjects: Adolescent; anemia; Anemia, Neonatal - complications; Anemia, Neonatal - therapy; blood transfusion; Child; Child Development; cognition disorders; Cognition Disorders - etiology; Developmental Disabilities - etiology; Disease Management; Erythrocyte Indices; Erythrocyte Transfusion - adverse effects; Erythrocyte Transfusion - methods; extremely low birth weight; Follow-Up Studies; Hematocrit; Hemoglobins; Humans; Infant; Infant, Extremely Low Birth Weight - growth & development; Infant, Newborn; Neonatal and Perinatal Medicine; Randomized Controlled Trials as Topic; Treatment Outcome; blood transfusion; follow-up studies; extremely low birth weight; child development; infant; anemia; cognition disorders
• ISSN: 0146-0005; 1558-075X
• DOI: 10.1053/j.semperi.2012.04.010

Surviving extremely low-birth-weight infants are at risk of severe neurodevelopmental disability. Transfusion with packed red cells is almost universal in the care of these infants, but the hemoglobin threshold at which these transfusions should be given is unclear. Different clinical trials of restrictive (low hemoglobin) versus liberal (high hemoglobin) thresholds have addressed either neurodevelopmental outcomes at 18-21 months of corrected gestational age or psychological tests and brain imaging at 8-15 years of age. Early follow-up shows differences in cognitive outcome favoring the liberal strategy, but as a post hoc secondary outcome. The childhood studies favor the restrictive strategy, but include major methodological problems of secondary recruitment. No firm conclusion can be reached, other than to report that serious adverse effects may be attributable to one or other of these strategies, that prudent practice is to remain within trial protocols, and that further redesigned clinical trials are required.