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TOPLINE: 

In infants with extremely low birthweight (ELBW), no difference in intermittent hypoxaemia (IH) or neurocognitive outcomes at 24 months was observed between liberal and restrictive red blood cell transfusion strategies, research showed.

METHODOLOGY: 

• This secondary analysis of the ETTNO trial included 554 infants with ELBW (< 1000 g) who had more than 80% completeness of oxygen saturation recordings during postnatal days 8-49.
• Participants (mean age, 2.5 days) were randomly assigned to receive either liberal (n = 268) or restrictive (n = 286) transfusion, with triggers depending on postnatal age and health status.
• Primary outcomes were the percentage time spent with IH and the number and mean duration of IH episodes during postnatal days 8-49; the secondary outcome was an interaction between exposure to IH and transfusion thresholds related to death or neurodevelopmental impairment (NDI) at 24 months of corrected age.

TAKEAWAY:

• The percentage time spent with IH and the number and mean duration of IH episodes were comparable between liberal and restrictive transfusion groups.
• Researchers found no interaction between exposure to IH and transfusion strategies on outcomes at 24 months.
• Among infants with above-median exposure to IH, death or NDI occurred in 54% of infants in the liberal group and 50% of infants in the restrictive transfusion group.

IN PRACTICE:

"Liberal transfusions, resulting in an overall mean haemoglobin increase of ~1 g/dL will not reduce IH during postnatal days 8-49. Hence, liberal transfusion strategies as in ETTNO should not be adopted to reduce IH (even though a RBCT [red blood cell transfusion] in an anaemic infant with severe IH may acutely/transiently reduce the burden of IH)," the authors wrote.

SOURCE:

This study was led by Axel R. Franz, University of Tübingen, Tübingen, Germany. It was published online on March 26, 2025, in Archives of Disease in Childhood-Fetal & Neonatal Edition.

LIMITATIONS:

Due to missing FiO₂ data, this study could not distinguish between normal SpO₂ > 97% and hyperoxaemia, limiting the calculations of target range and percentage time spent with hyperoxaemia. SpO₂ was less rigorously recorded than that in similar trials, and recordings that lasted beyond postnatal day 49 were limited due to early transfers. Only 55% of the ETTNO cohort was included; however, this subgroup appeared to be representative of the whole cohort. Additionally, the Bayley Mental Developmental Index Score used for cognitive assessment had limited accuracy.

DISCLOSURES: 

The ETTNO trial was funded by the German Research Foundation. The authors of this study reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.