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Adult donor red blood cell (RBC) concentrates represent the standard-of-care transfusion product used as the comparator arm in the BORN (umBilical blOod to tRansfuse preterm Neonates) clinical trial. Conducted by the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, this multicenter, double-blinded randomized controlled trial evaluates the impact of transfusion types on the development of retinopathy of prematurity (ROP) in extremely low gestational age neonates (ELGANs). Adult donor RBCs primarily contain adult hemoglobin (HbA), which has a lower oxygen affinity and different redox properties compared to fetal hemoglobin (HbF). The trial explores the hypothesis that the abrupt replacement of HbF with HbA through adult donor transfusions contributes to oxidative stress and fluctuations in oxygen delivery, potentially exacerbating the pathogenesis of severe ROP and bronchopulmonary dysplasia (BPD).
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