RBC transfusions in low-weight preterm infants are associated with retinopathy of prematurity (ROP), a visual impairment that affects their quality of life. Since a strong correlation exists between lower levels of fetal hemoglobin (HbF) and ROP, the BORN multicenter trial at eight Italian neonatal intensive care units randomized 112 extremely low gestational age neonates (born less than 28 weeks gestation) to receive either standard adult (A) RBCs or cord blood (CB) RBCs (collected from public CB banks not suitable for transplantation) until 30 weeks of gestational age. No differences in ROP, death, or adverse events were observed in the intention -to-treat analysis, but 42% (24/56) of neonates in the CB-arm received standard A-RBCs. In the as treated (or per protocol) analysis, 38 neonates received only A-RBCs and 17 received only CB-RBCs. While 34% (13/38) of neonates who received A-RBCs developed severe ROP, none developed severe ROP who received only CB-RBCs (risk difference, -0.34 [95% CI, -0.51 to -0.07]; p=0.005). Furthermore, 63% (24/38) of neonates who received A-RBCs developed bronchopulmonary dysplasia compared to 29% (5/17) of those who received CB-RBCs (p=0.039). While the results are promising that fetal Hb may protect extremely low gestational age neonates from ROB and bronchopulmonary dysplasia, further studies are needed, along with changes to cord blood collection methods to ensure a sufficient supply for neonatal transfusions.
Reference:
