Higher or Lower Hemoglobin Transfusion Thresholds for Preter
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Few studies claim that higher hemoglobin thresholds for red-cell transfusions may reduce the risk of cognitive delay among extremely-low-birth-weight infants with anemia.

Researchers 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. A total of 1824 infants underwent randomization.

Results:
There was a between-group difference of 1.9 g per deciliter in the pretransfusion mean hemoglobin levels throughout the treatment period.
--Primary outcome data were available for 1692 infants. Of 845 infants in the higher-threshold group, 423 died or survived with neurodevelopmental impairment, as compared with 422 of 847 infants in the lower-threshold group.
--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.

Through this study, it was concluded that 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.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2020248
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