{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:02:40Z","timestamp":1785391360095,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extremely low birth weight (ELBW) infants frequently require red blood cell (RBC) transfusions, yet optimal hemoglobin thresholds remain debated. Recent evidence supports restrictive transfusion strategies, but real-world implementation data in Chinese neonatal intensive care units (NICUs) are limited. This study aimed to evaluate the safety and efficacy of implementing a restrictive RBC transfusion protocol in ELBW infants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This multicenter before-after comparative study enrolled ELBW infants (birth weight &amp;lt; 1,000 g) admitted to two tertiary NICUs between January 2021 and December 2025 Infants admitted during the liberal transfusion period (January 2021\u2013December 2022\n                      <jats:italic>n<\/jats:italic>\n                      = 82) were compared with those admitted after implementation of a restrictive transfusion protocol (January 2023\u2013December 2025,\n                      <jats:italic>n<\/jats:italic>\n                      = 94). Liberal thresholds were hematocrit &amp;lt; 35% with respiratory support and &amp;lt; 30% without respiratory support; restrictive thresholds were hematocrit &amp;lt; 30% with respiratory support and &amp;lt; 25% without respiratory support. Primary outcomes included in-hospital mortality and composite neonatal morbidity. Secondary outcomes included the number of RBC transfusions, donor exposure, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were comparable between groups regarding gestational age (26.8 \u00b1 1.6 vs. 26.9 \u00b1 1.5 weeks,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.674), birth weight (811 \u00b1 124 vs. 804 \u00b1 130 g,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.713), and initial hematocrit (48.2 \u00b1 5.1 vs. 47.8 \u00b1 4.9%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.601). The restrictive group received significantly fewer RBC transfusions per infant (3.2 \u00b1 2.1 vs. 5.8 \u00b1 2.7, P &amp;lt; 0.001) and had reduced donor exposure (1.5 \u00b1 1.2 vs. 2.9 \u00b1 1.4 donors,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). In-hospital mortality did not differ significantly between groups (9.6% vs. 11.0%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.955). No significant differences were observed in the incidence of BPD (38.3% vs. 42.7%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.662), severe ROP requiring treatment (8.5% vs. 9.8%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.981), NEC \u2265 stage II (6.4% vs. 7.3%,\n                      <jats:italic>P<\/jats:italic>\n                      = 1.000), or severe IVH (grade III\u2013IV) (10.6% vs. 12.2%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.931). Length of hospital stay was similar between groups (78.4 \u00b1 24.3 vs. 81.2 \u00b1 26.6 days,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.465).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementation of a restrictive RBC transfusion strategy in ELBW infants significantly reduced transfusion requirements and donor exposure without increasing mortality or major neonatal morbidities. These findings support the adoption of restrictive transfusion thresholds in Chinese NICUs caring for ELBW infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1876529","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:40:52Z","timestamp":1785390052000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and efficacy of restrictive red blood cell transfusion strategy in extremely low birth weight infants: a before-after comparative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaozhi","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Neonatology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neonatology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.blre.2010.08.001","article-title":"Anaemia of prematurity: pathophysiology and treatment","volume":"24","author":"Strauss","year":"2010","journal-title":"Blood Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e520","DOI":"10.1542\/neo.9-11-e520","article-title":"Pathophysiology of anemia during the neonatal period, including anemia of prematurity","volume":"9","author":"Widness","year":"2008","journal-title":"Neoreviews."},{"key":"B3","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1159\/000486584","article-title":"Red blood cell transfusion in newborn infants: current evidence and controversies","volume":"114","author":"Howarth","year":"2018","journal-title":"Neonatology."},{"key":"B4","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1159\/000499048","article-title":"What is new about transfusions for preterm infants? 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