Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants

Cochrane Database Syst Rev. 2011 Nov 9;(11):CD000512. doi: 10.1002/14651858.CD000512.pub2.


Background: Infants of very low birth weight often receive multiple transfusions of red blood cells, usually in response to predetermined haemoglobin or haematocrit thresholds. In the absence of better indices, haemoglobin levels are imperfect but necessary guides to the need for transfusion. Chronic anaemia in premature infants may, if severe, cause apnoea, poor neurodevelopmental outcomes or poor weight gain.On the other hand, red blood cell transfusion may result in transmission of infections, circulatory or iron overload, or dysfunctional oxygen carriage and delivery.

Objectives: To determine if erythrocyte transfusion administered to maintain low as compared to high haemoglobin thresholds reduces mortality or morbidity in very low birth weight infants enrolled within three days of birth.

Search methods: Two review authors independently searched the Cochrane Central Register of Controlled Trials (The Cochrane Library) , MEDLINE,EMBASE, and conference proceedings through June 2010.

Selection criteria: We selected randomised controlled trials (RCTs) comparing the effects of early versus late, or restrictive versus liberal erythrocyte transfusion regimes in low birth weight infants applied within three days of birth, with mortality or major morbidity as outcomes.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anemia, Neonatal / blood*
  • Anemia, Neonatal / prevention & control
  • Biomarkers / blood
  • Blood Transfusion / standards*
  • Erythrocyte Transfusion / standards
  • Hematocrit / standards
  • Hemoglobin A / analysis*
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / blood*
  • Infant, Premature, Diseases / mortality
  • Infant, Premature, Diseases / prevention & control
  • Infant, Very Low Birth Weight / blood*
  • Morbidity
  • Randomized Controlled Trials as Topic
  • Reference Values


  • Biomarkers
  • Hemoglobin A