Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of red blood cell transfusion on short-term outcomes in very low birth weight infants

  • Lee, Eui Young (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Sung Shin (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Ga Young (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Sun Hyang (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine)
  • Received : 2019.08.19
  • Accepted : 2019.11.08
  • Published : 2020.02.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Red blood cell (RBC) transfusion improves cardiorespiratory status of preterm infants by increasing circulating hemoglobin, improving tissue oxygenation, and reducing cardiac output. However, RBC transfusion itself has also been suggested to negatively affect short-term outcomes such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in premature infants. Purpose: This study aimed to analyze the relationship between RBC transfusion and short-term outcomes in very low birth weight (VLBW) infants (birth weight, <1,500 g). Methods: We retrospectively reviewed the medical records of VLBW infants admitted to the Soonchunhyang University Bucheon Hospital between October 2010 and December 2017. Infants who died during hospitalization were excluded. The infants were divided into 2 groups according to RBC transfusion status. We investigated the relationship between RBC transfusion and short-term outcomes including BPD, ROP, NEC, and IVH. Results: Of the 250 enrolled VLBW infants, 109 (43.6%) underwent transfusion. Univariate analysis revealed that all short-term outcomes except early-onset sepsis and patent ductus arteriosus were associated with RBC transfusion. In multivariate analysis adjusted for gestational age, birth weight and Apgar score at 1 minute, RBC transfusion was significantly correlated with BPD (odds ratio [OR], 5.42; P<0.001) and NEC (OR, 3.40; P= 0.009). Conclusion: RBC transfusion is significantly associated with adverse clinical outcomes such as NEC and BPD in VLBW infants. Careful consideration of the patient's clinical condition and appropriate guidelines is required before administration of RBC transfusions.

Keywords

References

  1. Shim JW, Jin HS, Bae CW. Changes in survival rate for very-low-birthweight infants in Korea: comparison with other countries. J Korean Med Sci 2015;30 Suppl 1:S25-34. https://doi.org/10.3346/jkms.2015.30.S1.S25
  2. Widness JA, Madan A, Grindeanu LA, Zimmerman MB, Wong DK, Stevenson DK. Reduction in red blood cell transfusions among preterm infants: results of a randomized trial with an in-line blood gas and chemistry monitor. Pediatrics 2005;115:1299-306. https://doi.org/10.1542/peds.2004-1680
  3. Widness JA, Seward VJ, Kromer IJ, Burmeister LF, Bell EF, Strauss RG. Changing patterns of red blood cell transfusion in very low birth weight infants. J Pediatr 1996;129:680-7. https://doi.org/10.1016/S0022-3476(96)70150-6
  4. Baer VL, Lambert DK, Henry E, Snow GL, Christensen RD. Red blood cell transfusion of preterm neonates with a Grade 1 intraventricular hemorrhage is associated with extension to a Grade 3 or 4 hemorrhage. Transfusion 2011;51:1933-9. https://doi.org/10.1111/j.1537-2995.2011.03081.x
  5. Brooks SE, Marcus DM, Gillis D, Pirie E, Johnson MH, Bhatia J. The effect of blood transfusion protocol on retinopathy of prematurity: A prospective, randomized study. Pediatrics 1999;104(3 Pt 1):514-8. https://doi.org/10.1542/peds.104.3.514
  6. Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics 2012;129:529-40. https://doi.org/10.1542/peds.2011-2872
  7. Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants. Sci Rep 2014;4:4340. https://doi.org/10.1038/srep04340
  8. Baer VL, Lambert DK, Henry E, Snow GL, Butler A, Christensen RD. Among very-low-birth-weight neonates is red blood cell transfusion an independent risk factor for subsequently developing a severe intraventricular hemorrhage? Transfusion 2011;51:1170-8. https://doi.org/10.1111/j.1537-2995.2010.02980.x
  9. Hirano K, Morinobu T, Kim H, Hiroi M, Ban R, Ogawa S, et al. Blood transfusion increases radical promoting non-transferrin bound iron in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001;84:F188-93. https://doi.org/10.1136/fn.84.3.F188
  10. Collard KJ. Is there a causal relationship between the receipt of blood transfusions and the development of chronic lung disease of prematurity? Med Hypotheses 2006;66:355-64. https://doi.org/10.1016/j.mehy.2005.04.046
  11. Blau J, Calo JM, Dozor D, Sutton M, Alpan G, La Gamma EF. Transfusion-related acute gut injury: necrotizing enterocolitis in very low birth weight neonates after packed red blood cell transfusion. J Pediatr 2011;158:403-9. https://doi.org/10.1016/j.jpeds.2010.09.015
  12. Paul DA, Mackley A, Novitsky A, Zhao Y, Brooks A, Locke RG. Increased odds of necrotizing enterocolitis after transfusion of red blood cells in premature infants. Pediatrics 2011;127:635-41. https://doi.org/10.1542/peds.2010-3178
  13. Korean Society of Neonatology. Manual of neonatal care. 3rd ed. Seoul (Korea): Korean Society of Neonatology, 2014.
  14. Fasano RM, Said M, Luban NL. Blood component therapy for the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin's neonatal-perinatal medicine: Diseases of the fetus and infant. 10th ed. Philadelphia (PA): Elsevier Saunders, 2015:1344-61.
  15. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9. https://doi.org/10.1164/ajrccm.163.7.2011060
  16. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7. https://doi.org/10.1097/00000658-197801000-00001
  17. Fierson WM; American Academy of Pediatrics Section on Ophthalmology;American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2018;142:e20183061. https://doi.org/10.1542/peds.2018-3061
  18. Benson JE, Bishop MR, Cohen HL. Intracranial neonatal neurosonography: an update. Ultrasound Q 2002;18:89-114. https://doi.org/10.1097/00013644-200206000-00003
  19. Flodmark O, Roland EH, Hill A, Whitfield MF. Periventricular leukomalacia: radiologic diagnosis. Radiology 1987;162(1 Pt 1):119-24. https://doi.org/10.1148/radiology.162.1.3538143
  20. Dorner RA, Burton VJ, Allen MC, Robinson S, Soares BP. Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury. J Perinatol 2018;38:1431-43. https://doi.org/10.1038/s41372-018-0209-5
  21. Bak SY, Lee S, Park JH, Park KH, Jeon JH. Analysis of the association between necrotizing enterocolitis and transfusion of red blood cell in very low birth weight preterm infants. Korean J Pediatr 2013;56:112-5. https://doi.org/10.3345/kjp.2013.56.3.112
  22. Marin T, Josephson CD, Kosmetatos N, Higgins M, Moore JE. Feeding preterm infants during red blood cell transfusion is associated with a decline in postprandial mesenteric oxygenation. J Pediatr 2014;165:464-71. https://doi.org/10.1016/j.jpeds.2014.05.009
  23. Dani C, Reali MF, Bertini G, Martelli E, Pezzati M, Rubaltelli FF. The role of blood transfusions and iron intake on retinopathy of prematurity. Early Hum Dev 2001;62:57-63. https://doi.org/10.1016/S0378-3782(01)00115-3
  24. Wang YC, Chan OW, Chiang MC, Yang PH, Chu SM, Hsu JF, et al. Red blood cell transfusion and clinical outcomes in extremely low birth weight preterm infants. Pediatr Neonatol 2017;58:216-22. https://doi.org/10.1016/j.pedneo.2016.03.009
  25. Christensen RD, Baer VL, Lambert DK, Ilstrup SJ, Eggert LD, Henry E. Association, among very-low-birthweight neonates, between red blood cell transfusions in the week after birth and severe intraventricular hemorrhage. Transfusion 2014;54:104-8. https://doi.org/10.1111/trf.12234
  26. Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, et al. The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr 2006;149:301-7. https://doi.org/10.1016/j.jpeds.2006.05.011
  27. The Executive Committee of Korean Neonatal Networt. 2015 Korean neonatal network annual report. Cheongju (Korea): Korean Centers for Disease Control and Prevention, 2016.
  28. Keir AK, Yang J, Harrison A, Pelausa E, Shah PS; Canadian Neonatal Network. Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada. Transfusion 2015;55:1340-6. https://doi.org/10.1111/trf.12998
  29. Ohls RK. Why, when and how should we provide red cell transfusions to neonates? In: Polin RA, editor. Hematology, immunology and infectious disease: neonatology questions and controversies. Philadelphia (PA):Saunders, 2008:44-57.
  30. Howarth C, Banerjee J, Aladangady N. Red blood cell transfusion in preterm infants: current evidence and controversies. Neonatology 2018;114:7-16. https://doi.org/10.1159/000486584
  31. Heeger LE, Counsilman CE, Bekker V, Bergman KA, Zwaginga JJ, Te Pas AB, et al. Restrictive guideline for red blood cell transfusions in preterm neonates: effect of a protocol change. Vox Sang 2019;114:57-62. https://doi.org/10.1111/vox.12724
  32. Christensen RD, Ilstrup S. Recent advances toward defining the benefits and risks of erythrocyte transfusions in neonates. Arch Dis Child Fetal Neonatal Ed 2013;98:F365-72.