Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units

Abstract

BackgroundPreterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants.MethodsA prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis.ResultsA total of 2208 (51.6 %) infants received RBC transfusions (variation per neonatal unit: 34.1 % to 66.4 %). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born.ConclusionsThe frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.

The contribution of red blood cell transfusion to neonatal morbidity and mortality

“…Furthermore, in a retrospective study of 417 newborns already diagnosed with a grade 1 IVH, subsequent transfusion exposure, along with lower gestational age, was the most significant predictive factor in the 46 infants who subsequently developed grade III or IV haemorrhage . Similarly, in a prospective cohort of 4283 preterm newborns, those who received a transfusion had a 64% greater chance of diagnosis with grade III/IV haemorrhage . Following the implementation of a transfusion compliance programme, which was associated with a 23% reduction in the number of very low birthweight newborns transfused, the incidence of severe IVH similarly decreased from 17 to 8% .…”

Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

“…The median HbF estimates are shown in the lower section of Table III. Overall, 465 HbF measurements were included in the analysis, corresponding to an average of 20 determinations per patient (IQR [16][17][18][19][20][21][22]. Cord-RBCs and adult-RBCs transfusions elicited significantly different HbF values (P < 0Á0001).…”

Enterocolite necrosante e hemotransfusão: qual a relação?

“…Os pesquisadores, porém, ressalvam que os neonatos que necessitaram de transfusão apresentavam, em geral, outros fatores considerados confundidores, como baixa IG, baixo peso, maior risco de PCA e maior propensão à ventilação mecânica. [13][14][15] Esses fatores são encontrados nos dois casos aqui relatados. Os estudos observacionais e os relatos de caso, apesar de sua incapacidade de determinar relação causa-efeito, são importantes para a sugestão de possíveis fatores causais para os processos patológicos e podem orientar a necessidade de desenvolvimento de desenhos de estudo com maior grau de evidência.…”