Effects of Liberal Versus Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants：a Systematic Review and Meta-analysis of Randomized Trials

doi:10.3969/j.issn.1671-2587.2022.02.015

JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE ›› 2022, Vol. 24 ›› Issue (2): 211-217.DOI: 10.3969/j.issn.1671-2587.2022.02.015

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Effects of Liberal Versus Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants：a Systematic Review and Meta-analysis of Randomized Trials

ZHANG Yong-sheng, ZHENG Wei-wei, LIU Chang-qing

Department of Blood Transfusion,Kunshan Second People's Hospital,Jiangsu 215399

Received:2021-08-04 Published:2022-04-12

Abstract

Abstract: Objective To compare the effects of liberal transfusion strategy and restrictive transfusion strategy on death and neurodevelopmental impairment of extremely low birth weight（ELBW）infants. Methods We included randomized controlled trials（RCTs） comparing the effects of two blood transfusion strategies on the prognosis of ELBW infants,and conducted systematic review and Meta-analysis. The primary outcomes,measured at 18~26 months（corrected age）,was death or a composite of neurodevelopmental impairment（cognitive delay,cerebral palsy, hearing loss,vision loss）. We searched following English databases,PubMed,Cochrane Central Register of controlled Trials,EMBASE,Clinicaltrials until February 1,2021. In the Chinese databases,we searched CNKI,Wanfang Database,VIP and CBM. The retrieval deadline was August 11,2021. For binary variables,we calculated risk ration（RR）. Results A total of 3 288 infants from 3 RCTs were analyzed. 1 657 infants were randomly assigned to the restrictive transfusion group and 1 631 infants to the liberal transfusion group. There was no significant difference in the primary outcomes between the two groups （RR=1.01, 95%CI=0.93~1.09,I²=7%,P>0.05）. Statistical heterogeneity was observed only in the synthesized results of cognitive delay（I²=60%,P=0.08）. Conclusions For ELBW infants,restrictive transfusion strategy did not increase the likelihood of death or neurodevelopmental impairment at 18~26 months of corrected age.

Key words: Infant extremely low birth weight, Blood transfusion, Cognitive dysfunction, Survival

CLC Number:

R457

ZHANG Yong-sheng, ZHENG Wei-wei, LIU Chang-qing. Effects of Liberal Versus Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants：a Systematic Review and Meta-analysis of Randomized Trials[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2022, 24(2): 211-217.

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Effects of Liberal Versus Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants：a Systematic Review and Meta-analysis of Randomized Trials

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