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PEDIATRICS Vol. 104 No. 3 September 1999, pp. 514-518

The Effect of Blood Transfusion Protocol on Retinopathy of Prematurity: A Prospective, Randomized Study

Received Nov 2, 1998; accepted Mar 3, 1999.

Steven E. Brooks*, Dagger , Dennis M. Marcus*, Delores Gillis§, Elizabeth Pirie, CRNI§; Maribeth H. Johnsonparallel , and Jatinder BhatiaDagger

From the Departments of * Ophthalmology, Dagger  Pediatrics, and § Nursing; and the parallel  Office of Biostatistics, Medical College of Georgia, Augusta, Georgia.

Objective.  Controversy exists regarding the potential influence of anemia and blood transfusions on the rate of retinopathy of prematurity (ROP) in premature infants. A prospective, randomized, masked trial was performed to determine the influence of red blood cell transfusion protocol on ROP incidence and severity in a population of high-risk infants.

Methods.  A total of 50 infants with birth weights <1251 g were divided randomly into two groups beginning on day of life 29. Group 1 (n = 24) received red cell transfusions during the 6-week study period, only if certain symptom-based guidelines were met. Group 2 (n = 26) received red cell transfusions to maintain the hematocrit level above 40% for the entire 6 weeks. Infants were monitored for ROP, growth, and associated morbidity. Serial measurements of serum glucose, lactate, ferritin, total iron-binding capacity, and iron were performed.

Results.  ROP occurred in 83% of infants in group 1, and 73% of infants in group 2. There were no statistically significant differences in ROP severity, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, or any of the laboratory values except hemoglobin (10.8 vs 13.2 g/dL) and hematocrit (33.9% vs 41.8%) between the groups. Combining data from both groups, there was no association between hemoglobin or hematocrit ratios and ROP incidence or severity.

Conclusions.  A transfusion policy aimed at limiting the amount of blood given to premature infants (symptom-based) during the neonatal period does not impart a significantly different risk for ROP or other associated conditions, than does a policy in which transfusions are given more liberally for replacement purposes.  Key words:  retinopathy of prematurity, blood transfusion, prematurity, hematocrit.




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