Document Detail


Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion.
MedLine Citation:
PMID:  19117884     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: Extremely low birth weight infants frequently receive red cell transfusions. We sought to determine whether a restrictive versus liberal hemoglobin transfusion threshold results in differences in death or adverse neurodevelopmental outcomes of extremely low birth weight infants. PATIENTS AND METHODS: Extremely low birth weight infants previously enrolled in the Preterm Infants in Need of Transfusion Trial, a randomized, controlled trial of low versus high hemoglobin transfusion thresholds, were followed up at 18 to 21 months' corrected age. Erythrocyte transfusion was determined by an algorithm of low (restrictive) or high (liberal) hemoglobin transfusion thresholds, differing by 10 to 20 g/L and maintained until first hospital discharge. The primary composite outcome was death or the presence of cerebral palsy, cognitive delay, or severe visual or hearing impairment. RESULTS: Of 451 enrolled infants, the primary outcome was available in 430. There was no statistically significant difference in the primary outcome, found in 94 (45%) of 208 in the restrictive group and 82 (38%) of 213 in the liberal group. There were no statistically significant differences in preplanned secondary outcomes. However, the difference in cognitive delay (Mental Development Index score < 70) approached statistical significance. A posthoc analysis with cognitive delay redefined (Mental Development Index score < 85) showed a significant difference favoring the liberal threshold group. CONCLUSIONS: Maintaining the hemoglobin of extremely low birth weight infants at these restrictive rather than liberal transfusion thresholds did not result in a statistically significant difference in combined death or severe adverse neurodevelopmental outcome.
Authors:
Robin K Whyte; Haresh Kirpalani; Elizabeth V Asztalos; Chad Andersen; Morris Blajchman; Nancy Heddle; Meena LaCorte; Charlene M T Robertson; Maxine C Clarke; Michael J Vincer; Lex W Doyle; Robin S Roberts;
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  123     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-01     Completed Date:  2009-02-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  207-13     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. robin.whyte@dal.ca
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN72553588
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MeSH Terms
Descriptor/Qualifier:
Anemia, Neonatal / blood,  therapy
Blood Transfusion / methods*,  standards
Child Development / physiology*
Child, Preschool
Follow-Up Studies
Hemoglobins / administration & dosage*,  analysis
Humans
Infant
Infant, Extremely Low Birth Weight / blood*,  growth & development
Infant, Newborn
Time
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hemoglobins
Investigator
Investigator/Affiliation:
Angel Rios / ; Anthony Malone / ; P Graziano / ; Susan Boynton / ; Meena LaCorte / ; Patrick Leblanc / ; A Braithwaite / ; C Robertson / ; Maxine Clarke / ; Robin Whyte / ; Michael Vincer / ; Sharon Stone / ; Haresh Kirpalani / ; Morris A Blajchman / ; Nancy M Heddle / ; Marie Kim / ; Joanne Dix / ; Janice Cairnie / ; Chad Andersen / ; Anna Burdett / ; Lex Doyle / ; Kate Callanan / ; Noni Davis / ; Elaine Kelly / ; Geoff Ford / ; May Khairy / ; Elizabeth Asztalos / ; Maralyn Lacy / ; Denise Hohn / ; Robin Roberts / ; Carole Chambers / ; Lorrie Costantini / ; Kevin Thorpe /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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