Leading article
Critical haemoglobin thresholds in premature infants
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Introduction |
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Blood transfusion is an integral part of neonatal intensive care. Unfortunately, transfusion practice is often based on expert opinion1 2 and anecdote rather than scientific evidence. Historically, blood transfusions have been used as therapy for apnoea and bradycardia, poor feeding, poor weight gain, and pallor. Although many studies have examined these outcomes,3 few are methodologically sound, many lack sufficient power, and most contribute little to the discussion.
Theoretically, red blood cell transfusion is used to avoid the
pathological state in which oxygen demand is greater than
supply.4 5 As such, the principal outcome of any study of
transfusion practice would need to incorporate measures of end organ
hypoxia, specifically ischaemic brain injury, chronic lung disease,
retinopathy of prematurity, and death. At the present time there are no
methodologically sound prospective trials of transfusion practice that
include long term neurodevelopmental outcome, the end result of brain
hypoxia. This is in part because of
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Tschirch, E., Weber, B., Koehne, P., Guthmann, F., von Gise, A., Wauer, R. R., Rudiger, M.
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Kabra, N S
(2003). Blood transfusion in preterm neonates. Arch. Dis. Child. Fetal Neonatal Ed.
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Shiao, S.-Y. P.
(2002). Functional versus Fractional Oxygen Saturation Readings: Bias and Agreement Using Simulated Solutions and Adult Blood. Biol Res Nurs
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