RBC transfusion use in neonates requires more study

By Lauretta Ihonor, MedWire News Reporter

Results from a systematic review indicate that the safety and efficacy of red blood cell (RBC) transfusions in neonates is currently unclear and requires more precise study.

"Many trials failed to report on outcomes that would be considered of primary importance to clinicians. Consistent reporting of adverse events is required, and endpoints need to include neurodevelopmental outcomes," say the UK authors.

Writing in the British Journal of Haematology, Vidheya Venkatesh (Cambridge University Hospitals NHS Foundation Trust) and co-authors add that future research in this area will require improved methodology to fill in the blanks exposed by the current review.

The systematic review involved the evaluation of 27 randomized controlled trials (RCTs) in which neonates aged less than 28 days were given one or more RBC transfusions.

The outcomes of interest among these neonates were mortality, neurodevelopmental level at 2 years post-birth, and frequency rates of respiratory morbidities, such as chronic lung disease.

The RCTs were grouped into four categories based on their design and methodology. These were: trials in which RBC transfusion was compared with no transfusion or placebo (n=3); trials with different thresholds for transfusion (n=6); trials in which transfusion doses or administration schedules varied (n=4); and those in which the type of RBC transfusion given varied (n=14).

Venkatesh and team highlight that as only three of 27 trials compared RBC transfusion with no transfusion (or a placebo), it is difficult to draw valid conclusions about the true need for RBC transfusion in neonates.

Close assessment of the RCT designs revealed poor overall methodologic quality, say the authors.

Specifically, not only was there marked variability in the thresholds used to define when a transfusion was indicated, there was also a lack of consistency in how/if adverse events were reported.

Study sizes were also small, with most recruiting fewer than 30 patients in each trial arm.

Venkatesh et al conclude: "This comprehensive review has identified many areas of uncertainty in optimal neonatal RBC transfusion practice.

"The design of future RCTs can be informed by the lessons from this systematic review."

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