Restrictive versus liberal transfusion thresholds in very low birth weight infants: A systematic review with meta-analysis.

Peng Wang,Linjie Li,Haidong Deng,Yu Zhang,Yang Hai,Xing Wang,Weelic Chong,Harald Ehrhardt

doi:10.1371/journal.pone.0256810

Abstract

BackgroundTo assess the efficacy and safety of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants.MethodsWe searched MEDLINE, EMBASE, and Cochrane database without any language restrictions. The last search was conducted in August 15, 2020. All randomized controlled trials comparing the use of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight (VLBW) infants were selected. Pooled risk ratio (RR) for dichotomous variable with 95% confidence intervals were assessed by a random-effects model. The primary outcome was all-cause mortality.ResultsOverall, this meta-analysis included 6 randomized controlled trials comprising 3,483 participants. Restrictive transfusion does not increase the risk of all-cause mortality (RR, 0.99; 95% CI, 0.84 to 1.17; I2 = 0%; high-quality evidence), and does not increase the composite outcome of death or neurodevelopmental impairment (RR, 1.01, 95% CI, 0.93–1.09; I2 = 7%; high-quality evidence) or other serious adverse events. Results were similar in subgroup analyses of all-cause mortality by weight of infants, gestational age, male infants, and transfusion volume.ConclusionsIn very low birth weight infants, a restrictive threshold for red blood cell transfusion was not associated with increased risk of all-cause mortality, in either short term or long term.

Highlights

Up to 90% of the preterm infants with body weight at birth of less than 1000 g receive packed red blood cell (RBC) transfusion at least once during their hospital stay [1,2]
Restrictive transfusion does not increase the risk of all-cause mortality (RR, 0.99; 95% confidence intervals (CIs), 0.84 to 1.17; I2 = 0%; high-quality evidence), and does not increase the composite outcome of death or neurodevelopmental impairment (RR, 1.01, 95% CI, 0.93–1.09; I2 = 7%; high-quality evidence) or other serious adverse events
In very low birth weight infants, a restrictive threshold for red blood cell transfusion was not associated with increased risk of all-cause mortality, in either short term or long term

Summary

Introduction

Up to 90% of the preterm infants with body weight at birth of less than 1000 g receive packed red blood cell (RBC) transfusion at least once during their hospital stay [1,2]. Other research showed that RBC transfusion was associated with increased risk of adverse events and complications, including retinopathy of prematurity [9,10,11], bronchopulmonary dysplasia [12,13], necrotizing enterocolitis [14,15]. These complications raise concerns about the safety of this treatment method [16]. To assess the efficacy and safety of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants

Methods

Results

Conclusion