Most clinical practice guidelines for blood transfusion have focused on adults and limited recommendations are available for children and neonates. While restrictive hemoglobin thresholds are safe and effective for most patient subpopulations, questions remain about survival and the long-term neurological development in preterm infants who may need higher cerebral oxygenation levels. To provide recommendations for preterm infants, an international steering committee from the U.S. and Europe performed a systematic review of the six published randomized clinical trials (RCTs) that compared high versus low hemoglobin thresholds for transfusions in preterm infants. Based on data from 3,484 preterm infants (51% female; mean age range, 26 to 30 weeks), the committee found little difference in short- or long-term outcomes for high versus low hemoglobin thresholds. The committee recommended a restrictive RBC transfusion strategy for low-birth weight preterm infants based on their age and respiratory support needs. For preterm infants at postnatal weeks 1, 2, or >3 on respiratory support, recommendations for RBC transfusion hemoglobin thresholds were 11, 10, and 9 g/dL, respectively. For those preterm infants at postnatal weeks 1, 2, or >3 not on respiratory support, recommended RBC transfusion hemoglobin thresholds were 10, 8.5, and 7 g/dL, respectively. The committee noted that recommendations may not be applicable to every patient and may change with future evidence.
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