Increasing numbers of critically ill very low birth weight (VLBW) infants survive the neonatal period and develop anemia for which they receive multiple red blood cell (RBC) transfusions. Despite their prolonged medical treatment, we speculated that VLBW infants presently receive fewer RBC transfusions due to growing awareness of transfusion risks and improved care. RBC transfusion practices and clinical outcomes in consecutive infants with birth weights≤1.5 kg were analyzed retrospectively in 3 selected years: 1982--pre-HIV awareness; 1989--pre-surfactant availability; and 1993--pre-EPO usage. Progressive declines in mean (± SD) RBC transfusions, donor exposures and transfusion volumes per infant occurred concurrently (allP <0.0001, Table) with decreases in neonatal mortality and IVH, and no change in PDA, BPD or ROP. The decline in transfusion administration was associated with a decrease in pre-transfusion hematocrit (33.6% ± 2.8 in 1982, 34.2% ± 3.7 in 1989, and 29.8%± 5.1 in 1993, P <0.001). The distribution of RBC transfusions given by week of life among study years did not change - 70% were given within the first 4 weeks when infants are sickest. Although the percentage of VLBW infants >1 kg given no RBC transfusions increased (17% in 1982, 33% in 1989 and 64% in 1993), in all years >95% of infants ≤1 kg received transfusions.

Table 1
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Conclusions: 1) administration of RBC transfusions to VLBW infants has fallen markedly -- likely due to multiple factors; 2) mortality and morbidity were not increased by giving fewer transfusions; and 3) since most transfusions are given to infants ≤1 kg in the first weeks of life, therapeutic strategies should focus on these smaller infants during this critical period.