Clinical outcomes of restrictive versus liberal blood transfusion strategies in critical care children: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The published experience with restrictive and liberal blood transfusion approaches in pediatric intensive care units (ICUs) is not extensive. We investigated the outcomes of restrictive compared to liberal transfusion strategies in critically ill children. Methods: A search was conducted on PubMed, Embase, Scopus, and the Web of Science until February 16, 2024. The first 300 results from Google Scholar and records from the clinicaltrials.gov registry were manually screened. Backward and forward citation searches were also performed. We included randomized controlled trials examining outcome measures of children aged <18 years admitted to the ICUs who received restrictive methods for blood transfusion compared with the liberal one. Results: Ten studies were included, with a pooled sample size of 2736. Half (50.8 %) were males; age ranged from 2.5 days to 73.7 months. The restrictive transfusion strategy significantly decreased the risk of nosocomial infections (risk ratio: 0.64; 95 % confidence interval: 0.42, 0.96) and also reduced hemoglobin levels (standardized mean difference: −2.92; 95 % CI: −4.48, −1.35), while there were no significant changes between these blood transfusion strategies in terms of death, safety or adverse events, duration of hospital and ICU stay, and other measures, such as length of hospital and ICU stay, hematocrit, serum lactate, and serum ferritin levels. Quality assessment indicated that most studies had some concerns (n = 7), and others had high (n = 2) or low (n = 1) risk of bias. Conclusions: Restrictive transfusion strategy is safe and effective for critically ill children.

Keywords

• Red blood cell transfusion
• Restrictive
• Hemoglobin
• Threshold
• Children
• Intensive care