Effects of transfusions in extremely low birth weight infants: a retrospective study

Abstract

Objectives: To determine the risks and benefits associated with the transfusion of packed red blood cells (PRBCs) in extremely low birth weight (ELBW) infants. We hypothesized that when ELBW infants underwent transfusion with the University of Washington Neonatal Intensive Care Unit (NICU) 2006 guidelines, no clinical benefit would be discernible.

Study design: We conducted a retrospective chart review of all ELBW infants admitted to the NICU in 2006. Information on weight gain, apnea, heart rate, and respiratory support was collected for 2 days preceding, the day of, and 3 days after PRBC transfusion. The incidence, timing, and severity of complications of prematurity were documented.

Results: Of the 60 ELBW infants admitted to the NICU in 2006, 78% received PRBC transfusions. Transfusions were not associated with improved weight gain, apnea, or ventilatory/oxygen needs. However, they were associated with increased risk of bronchopulmonary dysplasia, necrotizing enterocolitis, and diuretic use (P < .05). Transfusions correlated with phlebotomy losses, gestational age, and birth weight. No association was found between transfusions and sepsis, retinopathy of prematurity, or erythropoietin use.

Conclusions: When our 2006 PRBC transfusion guidelines were used, no identifiable clinical benefits were identified, but increased complications of prematurity were noted. New, more restrictive guidelines were developed as a result of this study.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1

Distribution of PRBC transfusions by weeks of life and corrected GA. The histogram shows that PRBC transfusions are inversely correlated with GA and occur most frequently in the first 6 weeks of life. A, The Y axis shows the total number of transfusions; the X axis shows the week of life. B, transfusions per patient (Y axis) are shown as a function of gestational age (X axis).

Figure 2

Volume of PRBCs transfused and phlebotomized. The bar graph shows the mean (+ SEM) values for transfused and phlebotomized blood volumes per kg of birth weight. The scatter-plot compares the volumes and the Goodness of Fit value and regression line. Volume of blood transfused per kg of infant weight is 2 times higher than volume of blood phlebotomized (Non-parametric sign test, P < .0001).

Figure 3

Relationship of HCT to IVH in the first week of life. The graph shows both the birth HCT level (filled diamonds) and pre-transfusion HCT level (filled circles) as a function of IVH. For pre-transfusion HCT level, only the first transfusion was considered. No relationship existed between intracranial bleeding and HCT.