Red Blood Cell Transfusions at 21 Days of Age or Older in Previously Transfusion-Naive Very Preterm Infants: Association with Neonatal Outcomes

Abstract

Objective This study aims to assess the association of red blood cell (RBC) transfusion in a cohort of preterm infants with mortality, retinopathy of prematurity (ROP), and chronic lung disease (CLD) transfused at ≥ 21 days of life.

Study Design and Methods This retrospective cohort study included infants born at < 30 weeks' gestation who survived ≥ 21 days, had not received any RBC transfusions before reaching 21 days of age, and were admitted to participating units in the Canadian neonatal network (2003–2009).

Results Out of the 3,799 eligible infants, 3,309 infants did not receive RBC transfusion at  ≥ 21 days of age, whereas 490 received transfusion at  ≥ 21 days of age. Infants who did not receive RBC transfusion/s at  ≥ 21 days of age had higher birth weight (p < 0.01) and higher gestational age at the time of birth (p < 0.01) as compared with those who received transfusion/s at ≥ 21 days of age. Receipt of RBC transfusion/s at  ≥ 21 days of age was not associated with mortality (adjusted odds ratio [AOR] 1.20; 95% confidence interval [CI] 0.33–4.34) or severe ROP (AOR 1.02; 95% CI 0.59–1.77) but was associated with increased odds of CLD (AOR 1.78; 95% CI 1.43–2.22).

Conclusion RBC transfusion/s at  ≥ 21 days of age in previously transfusion-naive preterm infants was associated with increased odds of CLD but not with ROP or mortality.

Keywords

infant - newborn - premature - red blood cell transfusion - adverse effects

Site Investigators for the Canadian Neonatal Network

Prakesh S Shah (Director, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario; Adele Harrison, Victoria General Hospital, Victoria, British Columbia; Anne Synnes, British Columbia Children's Hospital, Vancouver, British Columbia; Zenon Cieslak, Royal Columbian Hospital, New Westminster, British Columbia; Todd Sorokan, Surrey Memorial Hospital, Surrey, British Columbia; Wendy Yee, Foothills Medical Centre, Calgary, Alberta; Khalid Aziz, Royal Alexandra Hospital, Edmonton, Alberta; Zarin Kalapesi, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, Royal University Hospital, Saskatoon, Saskatchewan; Mary Seshia, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; Ruben Alvaro, St. Boniface General Hospital, Winnipeg, Manitoba; Sandesh Shivananda, Hamilton Health Sciences Centre, Hamilton, Ontario; Orlando Da Silva, London Health Sciences Centre, London, Ontario; Chuks Nwaesei, Windsor Regional Hospital, Windsor, Ontario; Kyong-Soon Lee, Hospital for Sick Children, Toronto, Ontario; Prakesh Shah, Mount Sinai Hospital, Toronto, Ontario; Michael Dunn, Sunnybrook Health Sciences Centre, Toronto, Ontario; Nicole Rouvinez-Bouali, Children's Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario; Kimberly Dow, Kingston General Hospital, Kingston, Ontario; Ermelinda Pelausa, Jewish General Hospital, Montréal, Québec; Keith Barrington, Hôpital Sainte-Justine, Montréal, Québec; Christine Drolet, Centre Hospitalier Universitaire de Québec, Sainte Foy, Patricia Riley, Montréal Children's Hospital, Montréal, Québec; Daniel Faucher, Royal Victoria Hospital, Montréal, Québec; Valerie Bertelle, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Rody Canning, Moncton Hospital, Moncton, New Brunswick; Barbara Bulleid, Dr. Everett Chalmers Hospital, Fredericton, New Brunswick; Cecil Ojah and Luis Monterrosa, Saint John Regional Hospital, Saint John, New Brunswick; Akhil Deshpandey, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland; Jehier Afifi, IWK Health Centre, Halifax, Nova Scotia; Andrzej Kajetanowicz, Cape Breton Regional Hospital, Sydney, Nova Scotia; Shoo K Lee (Chairman, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario.

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