Letters to the Editor

To the Editor;

Re: RK Whyte, AL Jefferies; Canadian Paediatric Society, Fetus and Newborn Committee. Red blood cell transfusion in newborn infants. Paediatr Child Health 2014;19(4):213–222.

Many thanks to Drs Whyte and Jefferies for their excellent review of neonatal red blood cell transfusions, published in the April 2014 issue of the Journal, and their willingness to address this controversial topic. However, I would like to raise concerns regarding their recommended thresholds for transfusion for anemia of prematurity. The neurodevelopmental outcomes of the Premature Infants in Need of Transfusion (PINT) study, published in 2009 (1), clearly indicate (albeit in the authors’ post hoc analysis) a benefit of higher transfusion thresholds in reducing the rate of mild cognitive delay (motor development index [MDI] <85). In the absence of contradictory evidence, this critically important observation cannot be ignored.

This year’s updated Canadian Paediatric Society Position Statement recommendation on this matter states that “it would be prudent to maintain hemoglobin levels above the thresholds described in Table 1”, which references the lower transfusion thresholds from the PINT study.

In fact, what little evidence has been published on long-term neurodevelopmental outcomes supports the higher transfusion cut-off values. In light of this, the Position Statement should, at the very least, support individual centres’/clinicians’ choice to follow either set of thresholds. I have a feeling that many neonatologists around Canada share the same concern.

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