Objective The aim of this study was to compare the effect of PRBC transfusion volumes on cardiac function and haemodynamics.

Methods Seventy-one premature infants <30 weeks’ gestation were randomized to receive either 10 (lower) or 20 (higher) mL/kg of PRBC transfusion over 4 hours. A single investigator performed haemodynamic assessments using standard echocardiographic and Doppler techniques. Measurements were taken 4 hours before (B4), 4 hours after (A4), and 24 hours post-transfusion (A24). PDA was defined a priori. The effect of transfusion was studied by calculating the changes in haemodynamic parameters before and after transfusion (A4–B4).

Results Data from 69 infants was available for analysis, with 33 babies in the lower and 36 babies in the higher group. A significant PDA was present in 32 babies. Transfusion volume did not affect post-transfusion reduction in left ventricular cardiac output (CO). There was a significantly greater drop in SVC flow in the higher group (−39.0 ml/kg in higher vs. −7.9 ml/kg in lower; p = 0.036). While no effect was seen on systolic blood pressure, a significantly larger increase was found on diastolic BP in higher group post-transfusion (3.8 mm Hg in higher vs. 0.15 mm Hg in lower; p = 0.041). This increase in diastolic BP was seen in babies with ‘significant’ PDA (increase by 3.7 mm Hg in babies with PDA vs. 0.15 mm Hg in those without PDA, p = 0.043).

Conclusion PRBC transfusion of 20 mL/kg was associated with a significant decrease in SVC flow and an increase in diastolic BP as compared to transfusion of 10 mL/kg.