ArticleFrontiers in pediatrics2026
Impact of red blood cell transfusion and transfusion strategies on clinical outcomes in extremely low gestational age neonates.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate the effects of red blood cell transfusions and transfusion strategies on clinical outcomes in extremely low gestational age neonates (ELGANs). Methods: This retrospective cohort study enrolled 545 ELGANs with gestational age <28 weeks admitted between 2012 and 2024. Infants were divided into transfusion and non-transfusion groups. Tra nsfused infants were further classified into restrictive, liberal, and relatively liberal transfusion groups according to transfusion thresholds, and intergroup differences in clinical outcomes were analyzed. Multivariate logistic regression was performed to analyze the independent association between transfusion and outcomes, adjusted for treatment era (2012-2019 vs. 2020-2024), perinatal factors, postnatal illness severity, and treatment-related variables. Primary outcomes were bronchopulmonary dysplasia (BPD) and survival without severe complications. Secondary outcomes included severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), severe brain injury, and death. Results: A total of 545 ELGANs were included, with a median gestational age of 26.5 (IQR 25.6-27.2) weeks. Among them, 346 infants (63.5%) received at least one transfusion, with a total of 798 transfusion episodes and a median number of transfusions of 2 (IQR 1-3). Of the transfused infants, 82 (25.0%) were in the restrictive transfusion group, 138 (39.9%) in the liberal transfusion group, and 92 (26.6%) in the relatively liberal transfusion group. An increased number of transfusions was an independent risk factor for BPD (adjusted OR = 1.88, 95% CI: 1.48-2.40, Conclusions: In ELGANs, an increased number of transfusions is independently associated with a higher risk of BPD and lower survival without severe complications. A restrictive transfusion strategy safely reduces transfusion exposure without increasing the risk of major adverse outcomes and is recommended in clinical practice.
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