OBJECTIVETo evaluate the risks and benefits of two transfusion strategies (liberal-transfusion and restrictive-transfusion), as judged by the clinical progress and outcome, in very low birth weight infants.

METHODSThe clinical data of 93 hospitalized very low birth weight infants who required blood transfusions were retrospectively studied. The infants were assigned to either the liberal transfusion group (n=58), with higher hematocrit levels, or the restrictive-transfusion group (n=35), with lower hematocrit levels.

RESULTSThe infants in the restrictive-transfusion group received more numbers of RBC transfusions compared with the liberal-transfusion group (2.6+/-1.8 vs 1.8+/-1.0; p<0.05). Liberal-transfusion was associated with faster weight gain and the duration to return to the birth weight averaged 10 days in the liberal-transfusion group compared with 13 days in the restrictive-transfusion group (p<0.01). The infants in the liberal-transfusion group had shorter duration of mechanical ventilation than in the restrictive-transfusion group (5.5+/-4.2 days vs 8.0+/- 5.9 days; p<0.05). There were no significant differences in the incidence of apnea and nosocomial infections between two groups.

CONCLUSIONSThe study suggests the possible benefits from liberal-transfusion for clinical recovery in very low birth weight infants. The restrictive transfusion does not decrease the number of transfusions. It in fact increases the number of clinical indicated transfusions. Neonatologists should weigh the advantages and disadvantages on transfusions to make the optimal decision.