Higher or lower hemoglobin transfusion thresholds for preterm infants

Eunice Kennedy Shriver NICHD Neonatal Research Network

Résultat de recherche: Articleexamen par les pairs

187 Citations (Scopus)

Résumé

BACKGROUND Limited data suggest that higher hemoglobin thresholds for red-cell transfusions may reduce the risk of cognitive delay among extremely-low-birth-weight infants with anemia. METHODS We performed an open, multicenter trial in which infants with a birth weight of 1000 g or less and a gestational age between 22 weeks 0 days and 28 weeks 6 days were randomly assigned within 48 hours after delivery to receive red-cell transfusions at higher or lower hemoglobin thresholds until 36 weeks of postmenstrual age or discharge, whichever occurred first. The primary outcome was a composite of death or neurodevelopmental impairment (cognitive delay, cerebral palsy, or hearing or vision loss) at 22 to 26 months of age, corrected for prematurity. RESULTS A total of 1824 infants (mean birth weight, 756 g; mean gestational age, 25.9 weeks) underwent randomization. There was a between-group difference of 1.9 g per deciliter (19 g per liter) in the pretransfusion mean hemoglobin levels throughout the treatment period. Primary outcome data were available for 1692 infants (92.8%). Of 845 infants in the higher-threshold group, 423 (50.1%) died or survived with neurodevelopmental impairment, as compared with 422 of 847 infants (49.8%) in the lower-threshold group (relative risk adjusted for birth-weight stratum and center, 1.00; 95% confidence interval [CI], 0.92 to 1.10; P = 0.93). At 2 years, the higher- and lower-threshold groups had similar incidences of death (16.2% and 15.0%, respectively) and neurodevelopmental impairment (39.6% and 40.3%, respectively). At discharge from the hospital, the incidences of survival without severe complications were 28.5% and 30.9%, respectively. Serious adverse events occurred in 22.7% and 21.7%, respectively. CONCLUSIONS In extremely-low-birth-weight infants, a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity. (Funded by the National Heart, Lung, and Blood Institute and others; TOP ClinicalTrials.gov number, NCT01702805.)

Langue d'origineEnglish
Pages (de-à)2639-2651
Nombre de pages13
JournalNew England Journal of Medicine
Volume383
Numéro de publication27
DOI
Statut de publicationPublished - déc. 31 2020

Note bibliographique

Funding Information:
Supported by grants (U01 HL112776 and U01 HL112748, to Drs. Kirpalani, Bell, and Das) from the National Heart, Lung, and Blood Institute (NHLBI), grants (UG1 HD068244, UG1 HD053109, and U24 HD095254, to the Neonatal Research Network site investigators) from the NICHD, and grant support through cooperative agreements from the NIH, the NICHD, the NHBLI, the National Center for Research Resources, and the National Center for Advancing Translational Sciences.

Publisher Copyright:
Copyright © 2020 Massachusetts Medical Society.

ASJC Scopus Subject Areas

  • General Medicine

Empreinte numérique

Plonger dans les sujets de recherche 'Higher or lower hemoglobin transfusion thresholds for preterm infants'. Ensemble, ils forment une empreinte numérique unique.

Citer