Evaluation of the Effect of Blood Transfusion on Retinopathy of Prematurity at a Tertiary Care Center in Western Saudi Arabia

Abstract

Introduction We aim to study if there is an association between blood transfusions and the development and severity of retinopathy of prematurity (ROP). We also aim to explore the association with other clinical outcomes. Methods A cohort of 291 infants admitted to our neonatal intensive care unit (NICU) was retrospectively analyzed. The number and volume of RBC transfusions on Day 7 and Day 30 were recorded. Clinical outcomes including ROP, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and sepsis were noted. Results The mean gestational age (GA) and birth weight (BW) of the evaluated infants were 28 ± 2.2 weeks and 1062 ± 242 g, respectively. One hundred and eighteen infants were transfused at a median of nine days post GA. Compared to non-transfused infants, those who were transfused had a lower GA, a lower BW, a longer stay in the NICU, and received significantly more artificial ventilation. These infants also had a higher number of comorbidities, including sepsis and intraventricular hemorrhage. The number and volume of RBCs at Day 30 were significantly higher in infants with any stage of ROP than in those without ROP. Conclusion A higher frequency and volume of RBC transfusion were associated with an increased risk of ROP development. Whether this is a direct consequence of blood transfusion or the infants being at risk due to prematurity or low BW remains to be determined.

Association between red blood cell transfusion and bronchopulmonary dysplasia: a systematic review and meta-analysis

“…A total of 1,011 articles were retrieved from the databases using systematic and manual searches. After removing the duplicates, and performing screening of abstracts and full-text articles, 21 studies (5,15,16,19,20,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) were included. These studies included a total of 6,567 control infants and 1,476 patients with BPD, and were eligible for the meta-analysis.…”

“…In half of the included studies the primary objective was to investigate risk factors of BPD including RBCT. Two studies collected data based on medical records (16,26), and others defined BPD as neonates requiring oxygen support at 28 days of life or at 36 weeks of corrected GA. Study design included cross-sectional (n = 10), cohort (n = 9), and case-control (n = 2). The NOS scores of the included studies ranged from 4 to 8, and detailed information is provided in the supplemental files.…”

“…Recent studies have reported an association between RBCT and intra-ventricular hemorrhage, retinopathy of prematurity, and necrotizing enterocolitis (12)(13)(14). Few observational studies have found that patients with BPD receive higher RBCT volume and the number of RBCT is associated with BPD development (15)(16)(17). Vecchio et al instituted new guidelines for administering RBCT in their neonatal intensive care unit, and the transfusion rate was concordant with a lower incidence of BPD (18).…”

Jeddah Retinopathy of Prematurity (JED-ROP) Screening Algorithm

“… 8 To identify PWG screening criteria, we attempted to observe the weekly PWG and other significant risk factors based on logistic regressions from both hospitals to recommend cut-off points to improve the forecasting of type 1 and non-type 1 ROP development. Raffa and Aljohani 34 determined that a higher frequency and volume of red blood cell (RBC) transfusion were associated with increased risk of ROP development. The possible mechanisms underlying the complications associated with RBC transfusions in preterm infants include increased incidence of oxidative injury secondary to the increase in iron levels or the release of inflammatory mediators from stored blood products.…”

Progress in the study of association between hematological indicators and retinopathy of prematurity (Review)

“…Children with anemia who receive transfusions of adult red blood cells have a higher incidence of ROP compared with those who receive transfusions of autologous cord blood red cells. In addition, an association is found between the number of blood transfusions and ROP ( 36 ). A study suggests that performing ≥3 transfusions before 32 weeks gestation raises risk of ROP ( 37 ).…”