Kirpalani H, Bell EF, Hintz SR, Tan S, Schmidt B, Chaudhary AS, et al. Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. N Engl J Med. 2020;383(27):2639-51.
Study performed partly because of potential long term impacts found in the PINT trial (below). 1,800 ELBW babies randomized to higher or lower transfusion threshold. No advantage found of earlier transfusion in either short or long term outcomes. Absolutely no sign of any difference in Bayley scores.
Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, et al. The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr. 2006;149(3):301-7.
Comparison of two different transfusion threshold algorithms in 450 ELBW infants <48 h of age. No impact of more restrictive transfusions on any primary or secondary outcome, but many fewer transfusions in the restricted group.
Whyte RK, Kirpalani H, Asztalos EV, Andersen C, Blajchman M, Heddle N, et al. Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics. 2009;123(1):207-13.
Longer term outcomes of the PINT trial, no differences found in the planned analysis. A post-hoc analysis (always a dangerous thing to do) suggested that there was maybe an advantage in cognitive scores to the liberal transfusion group.
Platelets
Curley A, Stanworth SJ, Willoughby K, Fustolo-Gunnink SF, Venkatesh V, Hudson C, et al. Randomized Trial of Platelet-Transfusion Thresholds in Neonates. N Engl J Med. 2019;380(3):242-51..
Comparison of platelet transfusions at a threshold of either 50,000 or 25,000 in newborns not actively bleeding. No advantage of transfusing sooner, in fact there was more bleeding in the group who were transfused sooner. There were few very preterm babies in the first 48 hours of life, so little confidence for the impact on IVH, but no evidence of any benefit.
Neonatal Research 