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The paper by Wardle et al1 puts forward the interesting concept of the use of peripheral fractional oxygen extraction to guide blood transfusion in preterm infants. The clinical dilemma of deciding when to and when not to transfuse preterm neonates is always a major topic of debate among professionals involved in caring for preterm neonates. Ideas vary greatly about whether the cut off of haemoglobin concentration or packed cell volume should be used for transfusions in preterm babies.
There are not many randomised studies in the literature that examine this, and the few we know about either have methodological limitations or are not published in their full form.2–6 Therefore, as Wardle et al1 state, there is no doubt that we need more studies to produce evidence based guidelines for blood transfusion in preterm neonates. These studies should not only look at the number of transfusions, acute mortality, and morbidity but also developmental outcomes at 2–3 years of age. Can a …