BORN study: a multicenter randomized trial investigating cord blood RBC transfusions to reduce the ROP severity in extremely low gestational age neonates.

Abstract Background. Extremely low gestational age neonates (ELGAN, i.e., neonates born before 28 weeks of gestation), are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP. Methods/design. BORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent and randomization take place at 10 Neonatology Intensive Care Units (NICUs) of 8 Italian tertiary Hospitals. ELGANs with gestational age at birth comprised between 24 + 0 and 27 + 6 weeks are randomly allocated into two groups: 1) standard RBC transfusions (adult-RBCs) (control arm); 2) CB-RBCs (intervention arm). In case of transfusion need, enrolled patients receive transfusions according to the allocation arm, unless an ABO/RhD CB-RBC is unavailable. Nine Italian public CB banks cooperate to make available a suitable amount of CB-RBC units for all participating NICUs. The primary outcome is the incidence of severe ROP (stage 3 or higher) at discharge or 40 weeks of post-menstrual age, which occurs first. Discussion. BORN is a ground-breaking trial, pioneering a new transfusion approach dedicated to ELGANs at high risk for severe ROP. In previous non-randomized trials, this transfusion approach was proven feasible and able to prevent the HbF decrease in patients requiring multiple transfusions. Should the BORN trial confirm the efficacy of CB-RBCs in reducing ROP severity, this transfusion strategy would became the preferential blood product to be used in severely preterm neonates. Trial registration: ClinicalTrials.gov Identifier: NCT05100212