It is “virtually impossible” to create clinical guidelines for the treatment of premature babies with blood transfusions, experts have warned.
Around one in two premature babies with anaemia receives a transfusion of red blood cells (RBCs), but there’s a shortage of comparable scientific studies on the subject, they say.
Writing in Lancet Haematology, the team, led by Angelika Berger and Vito Giordano from the Division of Neonatology, Intensive Care Medicine and Neuropediatrics at MedUni Vienna's Department of Pediatrics and Adolescent Medicine, conducted a critical review of the currently available literature. They say there is sparse scientific evidence on RBC transfusions and highlight several issues that reduce comparability between studies, making it virtually impossible to incorporate the results into clinical guidelines.
They conclude that, on the basis of the available literature, they cannot determine reliably if RBC transfusions are associated with complications in preterm infants such as diseases of the intestine, retina or the lung, or with neurodevelopmental impairments.
Around 15 million babies are born prematurely every year, and every second premature baby is anaemic. Although recent advances in neonatal intensive care medicine have significantly reduced mortality rates, prematurity is still one of the leading causes of death in children under the age of five.
There is enormous potential for improving neonatal intensive care medicine, the study authors say.
“Our review is intended as an impetus to research and to develop improvements in therapeutic options for preterm infants,” said study leader Angelika Berger.
“One option might be the administration of foetal red blood cells, which could be obtained from umbilical cord blood. Premature babies are currently transfused with red blood cells from adult donors, and these are significantly different from those of newborns and might therefore be considered as physiologically unsuitable.”
The team plans to conduct further studies on this.
Source: Bellach L, Eigenschink M, Hassanein A, Savran D, Salzer U, Müllner EW, Repa A, Klebermass-Schrehof K, Wisgrill L, Giordano V, Berger A. (2022) “Packed red blood cell transfusion in preterm infants.” Lancet Haematol, 9(8):e615-e626. doi:10.1016/S2352-3026(22)00207-1
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