Red Blood Cell Transfusions are Independently Associated with Intra-Hospital Mortality in Very Low Birth Weight Preterm Infants

• Published in: The Journal of pediatrics Vol. 159; no. 3; pp. 371 - 376.e3
• Main Authors: dos Santos, Amélia Miyashiro Nunes, MD, PhD, Guinsburg, Ruth, MD, PhD, de Almeida, Maria Fernanda Branco, MD, PhD, Procianoy, Renato S., MD, PhD, Leone, Cléa Rodrigues, MD, PhD, Marba, Sérgio Tadeu Martins, MD, PhD, de Souza Rugolo, Ligia Maria Suppo, MD, PhD, Fiori, Humberto Holmer, MD, PhD, de Andrade Lopes, José Maria, MD, PhD, Martinez, Francisco Eulógio, MD, PhD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01-09-2011; Elsevier
• Subjects: Biological and medical sciences; Brazil - epidemiology; death; Diseases of mother, fetus and pregnancy; Enterocolitis, Necrotizing - epidemiology; Epidemiology; Erythrocyte Transfusion - adverse effects; Erythrocyte Transfusion - statistics & numerical data; erythrocytes; General aspects; guidelines; Gynecology. Andrology. Obstetrics; Hospital Mortality; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intracranial Hemorrhages - epidemiology; low birth weight; Medical sciences; mortality; neonates; Pediatrics; Pregnancy. Fetus. Placenta; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression Analysis; relative risk; Respiratory Distress Syndrome, Newborn - epidemiology; Sepsis - epidemiology; Brazil; Red blood cell; Score for Neonatal Acute Physiology–Perinatal Extension; RBC; IVH; Intraventricular hemorrhage; SNAPPE II; Human; Premature; Pediatrics; Transfusion; Pregnancy disorders; Mortality; Hospital environment; Infant; Epidemiology; Very low birthweight; Blood cell; Newborn diseases; Association; Prematurity; Hospital
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2011.02.040

Objective To test the hypothesis that red blood cell (RBC) transfusions in preterm infants are associated with increased intra-hospital mortality. Study design Variables associated with death were studied with Cox regression analysis in a prospective cohort of preterm infants with birth weight <1500 g in the Brazilian Network on Neonatal Research. Intra-hospital death and death after 28 days of life were analyzed as dependent variables. Independent variables were infant demographic and clinical characteristics and RBC transfusions. Results Of 1077 infants, 574 (53.3%) received at least one RBC transfusion during the hospital stay. The mean number of transfusions per infant was 3.3 ± 3.4, with 2.1 ± 2.1 in the first 28 days of life. Intra-hospital death occurred in 299 neonates (27.8%), and 60 infants (5.6%) died after 28 days of life. After adjusting for confounders, the relative risk of death during hospital stay was 1.49 in infants who received at least one RBC transfusion in the first 28 days of life, compared with infants who did not receive a transfusion. The risk of death after 28 days of life was 1.89 times higher in infants who received more than two RBC transfusions during their hospital stay, compared with infants who received one or two transfusions. Conclusion Transfusion was associated with increased death, and transfusion guidelines should consider risks and benefits of transfusion.