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Liberal Versus Restrictive Transfusion Guidelines for Preterm Infants

This study has been completed.
National Institutes of Health (NIH)
Information provided by:
University of Iowa Identifier:
First received: August 28, 2006
Last updated: NA
Last verified: August 2006
History: No changes posted
The purpose of this study was to determine whether restrictive guidelines for red blood cell (RBC) transfusions for preterm infants can reduce the number of transfusions without adverse consequences.

Condition Intervention
Infant, Premature
Intracranial Hemorrhages
Leukomalacia, Periventricular
Procedure: Red blood cell transfusion guidelines

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Randomized Trial of Liberal Versus Restrictive Guidelines for Red Blood Cell Transfusion in Preterm Infants

Resource links provided by NLM:

Further study details as provided by University of Iowa:

Primary Outcome Measures:
  • number of red blood cell transfusions
  • number of transfusion donors

Secondary Outcome Measures:
  • survival to discharge
  • patent ductus arteriosus
  • germinal matrix or intraventricular hemorrhage
  • periventricular leukomalacia
  • retinopathy of prematurity
  • bronchopulmonary dysplasia
  • duration of assisted ventilation
  • duration of supplemental oxygen therapy
  • number and frequency of all apnea episodes
  • number and frequency of apnea episodes requiring tactile stimulation
  • number and frequency of apnea episodes requiring assisted ventilation
  • number and frequency of apnea episodes during the 24 hours before and after each transfusion
  • time to regain birth weight
  • time to double birth weight
  • length of hospitalization
  • hemoglobin
  • hematocrit
  • reticulocyte count
  • oxygen saturation (pulse oximetry)
  • cardiac output (echocardiography)
  • blood lactic acid
  • plasma erythropoietin
  • serum ferritin

Estimated Enrollment: 100
Study Start Date: December 1992
Estimated Study Completion Date: June 1999
Detailed Description:

Design, Setting, and Patients. We enrolled 100 hospitalized preterm infants with birth weights 500 to 1300 g into a randomized clinical trial comparing two levels of hematocrit threshold for RBC transfusion.

Intervention. The infants were randomly assigned to either the liberal or the restrictive transfusion group. For each group, transfusions were given only when the hematocrit fell below the assigned value. In each group, the transfusion thresholds decreased with improving clinical status.

Main Outcome Measures. We recorded the number of transfusions, the number of donor exposures, and various clinical and physiological outcomes.

Results. Infants in the liberally transfused group received more RBC transfusions, mean 5.2 (SD 4.5) vs 3.3 (SD 2.9) in the restrictive transfusion group (P=0.025). However, the number of donors to whom the infants were exposed was not significantly different, mean 2.8 (SD 2.5) vs 2.2 (SD 2.0). There was no difference between the groups in the percentage of infants who avoided transfusions altogether, 12% in the liberal transfusion group vs 10% in the restrictive group. Infants in the restrictive group were more likely to have intraparenchymal brain hemorrhage or periventricular leukomalacia (P=0.012), and they had more frequent episodes of apnea (P=0.004), including both mild and severe episodes.


Ages Eligible for Study:   up to 2 Weeks   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Preterm infant
  • Birth weight 500-1300 grams

Exclusion Criteria:

  • Alloimmune hemolytic disease
  • Congenital heart disease
  • Other major birth defect requiring surgery
  • Chromosomal abnormality
  • Thought to be facing imminent death
  • Parental philosophical or religious objections to transfusion
  • More than 2 transfusions before enrollment
  • Participation in other research study with potential impact on this study
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Please refer to this study by its identifier: NCT00369005

Sponsors and Collaborators
University of Iowa
National Institutes of Health (NIH)
Principal Investigator: Edward F. Bell, M.D. University of Iowa
  More Information

Publications automatically indexed to this study by Identifier (NCT Number): Identifier: NCT00369005     History of Changes
Other Study ID Numbers: IowaBell001
P01HL046925 ( US NIH Grant/Contract Award Number )
M01RR000059 ( US NIH Grant/Contract Award Number )
Study First Received: August 28, 2006
Last Updated: August 28, 2006

Keywords provided by University of Iowa:
Infant, Premature

Additional relevant MeSH terms:
Intracranial Hemorrhages
Leukomalacia, Periventricular
Pathologic Processes
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Infant, Premature, Diseases
Infant, Newborn, Diseases processed this record on April 26, 2017