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• W2079149441 abstract "The PINT study1Kirpalani H. Whyte R. Andersen C. Asztalos E. Heddle N. Blajchman M. et al.The premature infants in need of transfusion (PINT) study: a randomized controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants.J Pediatr. 2006; 149: 301-307Abstract Full Text Full Text PDF PubMed Scopus (374) Google Scholar and the editorial by Bell2Bell E. Transfusion thresholds for preterm infants: how low should we go?.J Pediatr. 2006; 149: 287-289Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar discussed transfusion in preterm infants and drew different conclusions as to whether transfusion thresholds could be lower. Data from our institution (Middlemore Hospital) adds further information while we await further studies. In 2001, our transfusion guidelines were similar to those for the restrictive group of Bell et al.3Bell E.F. Strauss R.G. Widness J.A. Mahoney L.T. Mock D.M. Seward V. et al.Randomized trial of liberal versus restrictive guidelines for red cell transfusion in preterm infants.Pediatrics. 2005; 115: 1685-1691Crossref PubMed Scopus (353) Google Scholar Indications for transfusion in their study were as follows: phase 1 (respiratory illness and intubation), hematocrit < 34% (our unit, 30% to 34%); phase 2 (therapy with continuous positive airway pressure [CPAP] or oxygen), hematocrit < 28% (our unit, for CPAP with oxygen, 25% to 29%; for CPAP with room air, 20% to 24%). In phase 3 (neither CPAP nor oxygen), Bell et al maintained hematocrit > 22% (our unit, < 20%). Infants with birth weight < 1000 g and born after 22 weeks gestation were eligible (Table). Two periods were compared: January 2000 to August 2001, when hematocrit thresholds were 5% higher, and September 2001 to October 2004 when newer, more restrictive guidelines were adopted. Both groups received recombinant erythropoietin after 2 weeks.TableComparison of infants treated with the old and new transfusion protocolsOld protocolNew protocolPNumber3366Birth weight (g)800 (665 to 873)788 (684 to 880).77Gestation (weeks)25 (24 to 26)25 (24 to 26).30Male (%)5256.42Total transfusions (n)3 (2 to 4.5)2 (1 to 3).004Died (%)3321.14Any IVH (%)4229.18Grade 4 IVH (%)189.20PVL (%)93.10Grade 4 IVH or PVL (%)2411.13Data are expressed as median (interquartile range) or number (percentage). Open table in a new tab Data are expressed as median (interquartile range) or number (percentage). There were fewer transfusions with the newer protocol (hemoglobin difference between the old and new guidelines, 1.6 g/dL). Intraventricular hemorrhage (IVH) of all grades, but particularly grade 4, appeared less frequent with more restrictive guidelines. Overall, 6 of 12 cases had grade 4 hemorrhage by day 3, confirming the early onset and suggesting that erythropoietin was unlikely to have affected results. Interpretation of the composite grade 4 IVH/periventricular leukomalacia (PVL) outcome of Bell et al merits comment. Up to 2 transfusions before time of study entry were allowed (median age, 3 days, with no difference in transfusion before entry). Therefore, transfusion protocols were unlikely to have affected early IVH. Bell et al did not perform early head ultrasound. In addition, there were a high number of exclusions (76% of those meeting birth weight criteria). There were more boys in the restrictive group; male sex is associated with severe IVH.4Heuchan A.M. Evans N. Henderson Smart D.J. Simpson J.M. Perinatal risk factors for major intraventricular haemorrhage in the Australian and New Zealand Neonatal Network, 1995-97.Arch Dis Child Fetal Neonatal Ed. 2002; 86: 86-90Crossref Google Scholar Therefore, the groups may have been unequal with regard to IVH status at study entry. A single case of grade 4 IVH or PVL in the liberal transfusion group would render the results statistically insignificant; thus, the study of Bell et al is likely flawed in terms of neurologic outcome. Results from our institution do not support the concerns of Bell et al, but do add weight to the conclusions of the PINT study that transfusion thresholds can be moved downward." @default.
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• W2079149441 date "2007-06-01" @default.
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• W2079149441 title "Transfusion thresholds for preterm infants" @default.
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• W2079149441 doi "https://doi.org/10.1016/j.jpeds.2007.02.031" @default.
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