Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g

Objective: Extremely low birth weight (ELBW) infants frequently undergo tra nsfusion because they are critically ill, often need artificial ventilation , and have the highest blood sampling loss in relation to their weight. Dur ing the last decade our transfusion guidelines were changed 3 times to beco me more restrictive. We hypothesized that these modifications substantially decreased the number of transfusions in our ELBW infants. Methods: We performed a single-center analysis of 256 infants with birth we ights from 500 to 999 g who were admitted from 1989 to 1997 and included 3 study periods, each starting with newly modified transfusion guidelines in April 1989, September 1991, and January 1995. We evaluated prospectively re corded clinical data and retrospective chart analysis for transfusion-relat ed information. Results: The median number of transfusions per infant decreased from 7 in t he first period to 2 in the third period, whereas donor exposure decreased from 5 to 1 and blood volume transfused decreased from 131 to 37 mL/kg birt h weight (P < .01). The median venous hematocrit measured before transfusio n decreased from 43% to 35% in infants who underwent ventilation and from 4 1% to 31% in spontaneously breathing infants. The median birth weight decre ased fr om 870 to 740 g and the median gestational age from 27 to 25 comple ted weeks (P < .01). The overall survival rate was 75% and did not change. The incidences of retinopathy, intraventricular hemorrhage, and patent duct us arteriosus remained unchanged. Conclusion: Over this 9-year period with increasingly restrictive transfusi on guidelines, the transfusion number decreased by 71% and the donor exposu re by 80% in ELBW infants without adverse clinical effects.