05 January 2021

There is no benefit to raising the haemoglobin threshold for blood transfusions for extremely low birthweight babies, according to a new analysis.

Babies who are born before 29 weeks of pregnancy or weigh less than 1,000 grams have a raised risk of mortality or neurological impairment due to anaemia and a reduced ability to produce red blood cells.

For many years, doctors have considered the possibility of raising the haemoglobin threshold for red cell transfusions, maintaining higher haemoglobin levels than currently recommended, to improve their outcomes

This new study was carried out by Dr Haresh Kirpalani of the University of Pennsylvania, USA, and colleagues. The study analysed the outcomes for a total of 1824 very low birthweight infants participated in the trial, 845 of whom were assigned to the higher haemoglobin target following blood transfusions.

Among the babies assigned to the higher threshold, 50.1% died or survived with a neurodevelopmental impairment. For the group of 847 babies assigned to the standard lower haemoglobin threshold, 49.8% died or had a neurodevelopmental impairment.

Looked at separately, death rates in the high threshold group were 16.2% versus 15% in the standard threshold group, and rates of neurodevelopmental impairment were 39.6% in the high haemoglobin group versus 40.3%. The authors concluded that there was no statistically significant benefit to raising the haemoglobin threshold for extremely low birthweight babies.

The research appeared in the New England Journal of Medicine in December 2020.

Dr Kirpalani says: “Providing a higher threshold of red cells within accepted limits offers no advantage in survival or reduction in neurological impairment over a lower threshold.”


Kirpalani H, Bell EF, Hintz SR, Tan S, Schmidt B, Chaudhary AS, Johnson KJ, Crawford MM, Newman JE, Vohr BR, Carlo WA, D'Angio CT, Kennedy KA, Ohls RK, Poindexter BB, Schibler K, Whyte RK, Widness JA, Zupancic JAF, Wyckoff MH, Truog WE, Walsh MC, Chock VY, Laptook AR, Sokol GM, Yoder BA, Patel RM, Cotten CM, Carmen MF, Devaskar U, Chawla S, Seabrook R, Higgins RD, Das A; Eunice Kennedy Shriver NICHD Neonatal Research Network. (2020) “Higher or lower hemoglobin transfusion thresholds for preterm infants.” N Engl J Med, doi: 10.1056/nejmoa2020248

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