{
  "abstract": "Objectives To compare the effect of liberal versus restrictive transfusion strategies on the proportion of time (%time) spent with intermittent hypoxaemia (IH, ie, arterial haemoglobin oxygen saturation measured by pulse oximetry (SpO 2) <80% lasting ≥60 s) in the ‘Effects of Transfusion Thresholds on Neurocognitive Outcome’ (ETTNO) population, and to investigate whether infants with above-median exposure to IH might benefit more from liberal transfusion strategies than those with lower exposure.Design, setting, patients Secondary analysis in all 554/1013 infants of <1000 g birth weight recruited into the ETTNO trial (mean gestational age 26.2 weeks) with >80% completeness of SpO 2 recordings during postnatal days 8–49.Intervention Randomly assigned liberal (n=268) or restrictive (n=286) transfusion strategies, defining transfusion triggers based on postnatal age and health status.Main outcome measures %time with IH, rate and mean duration of IH episodes during postnatal days 8–49. Interaction between exposure to IH and transfusion strategies with respect to ETTNO’s composite primary outcome, death or disability at 24 months corrected age.Results The median (quartile 1–quartile 3) %time with IH was similar between treatment groups (0.91% (0.13%–2.83%) with liberal vs 0.79% (0.16%–2.44%) with restrictive transfusions). There was no interaction between exposure to IH and transfusion strategies on outcome at 24 months.Conclusions In infants <1000 g birth weight, a liberal transfusion strategy did not reduce IH. Blood transfusions should not be administered ‘liberally’ to reduce IH or to improve neurocognitive outcome in infants with above-average exposure to IH.Trial registration number NCT01393496.",
  "authors": [
    {
      "affiliations": [
        "Center for Pediatric Clinical Studies, University of Tübingen, Tubingen, Germany",
        "Neonatology, University Children’s Hospital Tübingen, Tübingen, Germany"
      ],
      "name": "Axel R Franz"
    },
    {
      "affiliations": [
        "Center for Pediatric Clinical Studies, University of Tübingen, Tubingen, Germany"
      ],
      "name": "Corinna Engel"
    },
    {
      "affiliations": [
        "Neonatology, UniversitatsSpital Zurich Klinik fur Neonatologie, Zurich, Switzerland"
      ],
      "name": "Dirk Bassler"
    },
    {
      "affiliations": [
        "Department for Neonatology and Paediatric Intensive Care Medicine, Medizinische Fakultät, Technische Universitat Dresden, Dresden, Germany"
      ],
      "name": "Mario Rüdiger"
    },
    {
      "affiliations": [
        "Neonatology, University of Leipzig, Leipzig, Germany"
      ],
      "name": "Ulrich H Thome"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Children’s Hospital, Philipps University Marburg, Marburg, Germany"
      ],
      "name": "Rolf F Maier"
    },
    {
      "affiliations": [
        "University Children’s Hospital Tuebingen, Tuebingen, Germany"
      ],
      "name": "Ingeborg Krägeloh-Mann"
    },
    {
      "affiliations": [
        "Neonatology and Pediatric Intensive Care Medicine, Ulm University Medical Center, Ulm, Germany"
      ],
      "name": "Jochen Essers"
    },
    {
      "affiliations": [
        "Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany"
      ],
      "name": "Christoph Bührer"
    },
    {
      "affiliations": [
        "Neonatology, Helios Klinik Erfurt, Erfurt, Germany"
      ],
      "name": "Hans-Jörg Bittrich"
    },
    {
      "affiliations": [
        "Neonatology and Paediatric Intensive Care, Vest Childern’s Hospital Datteln, University Witten-Herdecke, Datteln, Germany"
      ],
      "name": "Claudia Roll"
    },
    {
      "affiliations": [
        "University Hospital Düsseldorf Neonatology and Pediatric Intensive Care, Düsseldorf, Germany"
      ],
      "name": "Thomas Höhn"
    },
    {
      "affiliations": [
        "Neonatology and Pediatric Intensive Care Medicine, Ulm University Medical Center, Ulm, Germany",
        "General Pediatrics & Neonatology, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany"
      ],
      "name": "Harald Ehrhardt"
    },
    {
      "affiliations": [
        "Universitatsklinikum Magdeburg, Magdeburg, Germany"
      ],
      "name": "Ralf Boettger"
    },
    {
      "affiliations": [
        "Neonatology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany"
      ],
      "name": "Hans Thorsten Körner"
    },
    {
      "affiliations": [
        "Pediatrics-Neonatology, University Hospital Essen, Essen, Germany"
      ],
      "name": "Anja Stein"
    },
    {
      "affiliations": [
        "Neonatology, Olgahospital Stuttgart, Stuttgart, Germany"
      ],
      "name": "Patrick Neuberger"
    },
    {
      "affiliations": [
        "Child and Adolescent Health, Aarhus University Hospital, Aarhus N, Denmark"
      ],
      "name": "Tine Brink Henriksen"
    },
    {
      "affiliations": [
        "Neonatology, Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Gorm Greisen"
    },
    {
      "affiliations": [
        "Neonatology, University of Tübingen, Tubingen, Germany"
      ],
      "name": "Christian F Poets"
    },
    {
      "affiliations": [],
      "name": "for the ETTNO Investigators"
    }
  ],
  "title": "Effects of liberal versus restrictive transfusion strategies on intermittent hypoxaemia in extremely low birthweight infants: secondary analyses of the ETTNO randomised controlled trial",
  "uid": "822dd3d3-6e9b-57b0-b767-330272cff5f1"
}