Most extremely low birth-weight (ELBW) infants develop anemia, which can result in severe brain injury and/or impaired oxygen supply to the brain. Some studies have suggested that liberal transfusion strategies may be best for ELBW infants, but RBC transfusions are also associated with severe adverse events in ELBW infants. The Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants (ETTNO) trial was, therefore, designed to compare the effects of restrictive versus liberal transfusion strategies on risk of death and neurocognitive outcomes in ELBW infants. This clinical trial randomized 1013 ELBW infants (median gestational age, 26.3 weeks; median birth weight 750 g; 50.2% female) born at 36 hospitals in Europe to either liberal (N=492) or restrictive (N=521) transfusion groups, and the infants were followed for at least 24 months. Eighty-one percent of the infants (400/492) in the liberal transfusion group received at least one transfusion compared to 60.5% in the restrictive group (315/521). The occurrence of death, cognitive defects, or cerebral palsy was not significantly different between the two groups at 24 months of corrected age (P>0.37 for all comparisons). Ongoing studies comparing transfusion strategies in premature infants will be helpful to confirm that restrictive transfusion strategies are safe for these patients.
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