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Am J Perinatol
DOI: 10.1055/a-2051-8245
Original Article

Packed Red Blood Cell Transfusion as a Predictor of Moderate–Severe Bronchopulmonary Dysplasia: A Comparative Cohort Study of Very Preterm Infants

Fatih Bolat
1   Division of Neonatology, Department of Pediatrics, Istinye University Faculty of Medicine, Istanbul, Turkey
,
Mesut Dursun
2   Division of Neonatology, Department of Pediatrics, Biruni University Faculty of Medicine, Istanbul, Turkey
,
Mehmet Sarıaydın
2   Division of Neonatology, Department of Pediatrics, Biruni University Faculty of Medicine, Istanbul, Turkey
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Abstract

Objective Bronchopulmonary dysplasia (BPD) is a leading cause of morbidity and mortality in neonatal intensive care units. Our aim was to evaluate association between packed red blood cell transfusion and the development of BPD in very preterm infants.

Study Design This retrospective study of very preterm infants (mean gestational age: 27.1 ± 2.4 weeks, birth weight: 970 ± 271 g) was conducted at Biruni University (Turkey) between July 2016 and December 2020.

Results BPD developed in 107 of the 246 enrolled neonates, including 47 (43.9%), 27 (25.3%), and 33 (30.8%) diagnosed with mild, moderate, and severe BPD, respectively. A total of 728 transfusions were administered. The increased number (4 transfusions [2–7] vs. 1 [1–3], p = 0.001) and volume of transfusions (75 mL/kg volume [40–130] vs. 20 [15–43], p = 0.001) were significantly higher in infants with BPD compared to those without BPD. The transfusion volume cut-off for the prediction of BPD by receiver operating characteristic curve analysis was 42 mL/kg (sensitivity 73.6%; specificity 75%; area under the receiver-operating characteristic curve: 0.82). In multivariate analysis, multiple transfusions and larger transfusion volume were independent risk factors for moderate–severe BPD.

Conclusion The increased number and volume of transfusions were associated with BPD in very preterm infants. A packed red blood cell transfusion volume ≥42 mL/kg was a statistically significant predictor of the development of BPD at a postmenstrual age of 36 weeks.

Key Points

  • Transfusions were found to be an important risk factor for BPD development in very premature infants.

  • Number and volume of transfusion were associated with the severity of BPD.

  • Optimal cut point volume of transfusion for prediction of BPD was 42 mL/kg body weight.

Keywords

packed red blood cell transfusion - bronchopulmonary dysplasia - risk factor - very preterm


Publication History

Received: 01 September 2022

Accepted: 24 February 2023

Accepted Manuscript online:
10 March 2023

Article published online:
10 April 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Kalteren WS, Verhagen EA, Mintzer JP, Bos AF, Kooi EMW. Anemia and red blood cell transfusions, cerebral oxygenation, brain injury and development, and neurodevelopmental outcome in preterm infants: a systematic review. Front Pediatr 2021; 9: 644462
    CrossrefPubMedGoogle Scholar
  • 2 Whyte R, Kirpalani H. Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. Cochrane Database Syst Rev 2011; 11 (11) CD000512
    PubMedGoogle Scholar
  • 3 Song J, Dong H, Xu F. et al. The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates. PLoS One 2021; 16 (07) e0254810
    CrossrefPubMedGoogle Scholar
  • 4 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 (01) 104-108
    CrossrefPubMedGoogle Scholar
  • 5 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 (06) 1170-1178
    CrossrefPubMedGoogle Scholar
  • 6 Hengartner T, Adams M, Pfister RE. et al; Swiss Neonatal Network. Associations between red blood cell and platelet transfusions and retinopathy of prematurity. Neonatology 2020; 117 (05) 1-7
    CrossrefPubMedGoogle Scholar
  • 7 Silvers KM, Gibson AT, Russell JM, Powers HJ. Antioxidant activity, packed cell transfusions, and outcome in premature infants. Arch Dis Child Fetal Neonatal Ed 1998; 78 (03) F214-F219
    CrossrefPubMedGoogle Scholar
  • 8 Crawford TM, Andersen CC, Hodyl NA, Robertson SA, Stark MJ. Effect of washed versus unwashed red blood cells on transfusion-related immune responses in preterm newborns. Clin Transl Immunology 2022; 11 (03) e1377
    CrossrefPubMedGoogle Scholar
  • 9 Kalhan TG, Bateman DA, Bowker RM, Hod EA, Kashyap S. Effect of red blood cell storage time on markers of hemolysis and inflammation in transfused very low birth weight infants. Pediatr Res 2017; 82 (06) 964-969
    CrossrefPubMedGoogle Scholar
  • 10 Liao Z, Zhao X, Rao H, Kang Y. Analysis of correlative risk factors for blood transfusion therapy for extremely low birth weight infants and extreme preterm infants. Am J Transl Res 2021; 13 (07) 8179-8185
    PubMedGoogle Scholar
  • 11 Kültürsay N, Bilgen H, Türkyılmaz C. Turkish Neonatal Society guideline on enteral feeding of the preterm infant. Turk Pediatri Ars 2018; 53 (suppl 1): S109-S118
    PubMedGoogle Scholar
  • 12 New HV, Berryman J, Bolton-Maggs PH. et al; British Committee for Standards in Haematology. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol 2016; 175 (05) 784-828
    CrossrefPubMedGoogle Scholar
  • 13 Çetinkaya M, Atasay B, Perk Y. Turkish Neonatal Society guideline on the transfusion principles in newborns. Turk Pediatri Ars 2018; 53 (suppl 1): S101-S108
    CrossrefPubMedGoogle Scholar
  • 14 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 15 Gibbs RS, Blanco JD, St Clair PJ, Castaneda YS. Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term. J Infect Dis 1982; 145 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 16 Walti H, Couchard M, Relier JP. Neonatal diagnosis of respiratory distress syndrome. Eur Respir J Suppl 1989; 3: 22s-26s
    PubMedGoogle Scholar
  • 17 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
    CrossrefPubMedGoogle Scholar
  • 18 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 19 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
    CrossrefPubMedGoogle Scholar
  • 20 Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017; 390 (10104): 1770-1780
    CrossrefPubMedGoogle Scholar
  • 21 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 22 Valieva OA, Strandjord TP, Mayock DE, Juul SE. Effects of transfusions in extremely low birth weight infants: a retrospective study. J Pediatr 2009; 155 (03) 331-37.e1
    CrossrefPubMedGoogle Scholar
  • 23 Shanmugha Priya RA, Krishnamoorthy R, Panicker VK, Ninan B. Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: a descriptive study. Asian J Transfus Sci 2018; 12 (01) 34-41
    CrossrefPubMedGoogle Scholar
  • 24 Chen HL, Tseng HI, Lu CC, Yang SN, Fan HC, Yang RC. Effect of blood transfusions on the outcome of very low body weight preterm infants under two different transfusion criteria. Pediatr Neonatol 2009; 50 (03) 110-116
    CrossrefPubMedGoogle Scholar
  • 25 Duan J, Kong X, Li Q. et al. Association between anemia and bronchopulmonary dysplasia in preterm infants. Sci Rep 2016; 6: 22717
    CrossrefPubMedGoogle Scholar
  • 26 Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants. Sci Rep 2014; 4: 4340
    CrossrefPubMedGoogle Scholar
  • 27 Cooke RW, Drury JA, Yoxall CW, James C. Blood transfusion and chronic lung disease in preterm infants. Eur J Pediatr 1997; 156 (01) 47-50
    CrossrefPubMedGoogle Scholar
  • 28 Ming S, Zhang D, Chen L, Shi Y. Effects of anemia and red blood cell transfusion in preterm infants on the development of bronchopulmonary dysplasia: a propensity score analysis. All Life 2021; 14: 830-839
    CrossrefPubMedGoogle Scholar
  • 29 D'Amato G, Faienza MF, Palladino V. et al. Red blood cell transfusions and potentially related morbidities in neonates under 32 weeks' gestation. Blood Transfus 2021; 19 (02) 113-119
    PubMedGoogle Scholar
  • 30 Del Vecchio A, Henry E, D'Amato G. et al. Instituting a program to reduce the erythrocyte transfusion rate was accompanied by reductions in the incidence of bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis. J Matern Fetal Neonatal Med 2013; 26 (suppl 2): 77-79
    CrossrefPubMedGoogle Scholar
  • 31 Franz AR, Engel C, Bassler D. et al; ETTNO Investigators. Effects of liberal vs restrictive transfusion thresholds on survival and neurocognitive outcomes in extremely low-birth-weight infants: the ETTNO randomized clinical trial. JAMA 2020; 324 (06) 560-570
    CrossrefPubMedGoogle Scholar
  • 32 Kirpalani H, Bell EF, Hintz SR. et al; Eunice Kennedy Shriver NICHD Neonatal Research Network. Higher or lower hemoglobin transfusion thresholds for preterm infants. N Engl J Med 2020; 383 (27) 2639-2651
    CrossrefPubMedGoogle Scholar
  • 33 Bell EF. Red cell transfusion thresholds for preterm infants: finally some answers. Arch Dis Child Fetal Neonatal Ed 2022; 107 (02) 126-130
    CrossrefPubMedGoogle Scholar
  • 34 Paul DA, Leef KH, Locke RG, Stefano JL. Transfusion volume in infants with very low birth weight: a randomized trial of 10 versus 20  ml/kg. J Pediatr Hematol Oncol 2002; 24 (01) 43-46
    CrossrefPubMedGoogle Scholar
  • 35 Davies P, Robertson S, Hegde S, Greenwood R, Massey E, Davis P. Calculating the required transfusion volume in children. Transfusion 2007; 47 (02) 212-216
    CrossrefPubMedGoogle Scholar
  • 36 Cheema RK, Jain S, Bedi RK, Kaur G, Chawla D. Comparison of hematocrit change in preterm neonates with birth weight based versus formula based packed red blood cell transfusion: a randomized control trial. Indian J Hematol Blood Transfus 2022; 38 (01) 138-144
    CrossrefPubMedGoogle Scholar
  • 37 Mehl SC, Portuondo JI, Pettit RW. et al. Association of red blood cell transfusion volume with postoperative complications and mortality in neonatal surgery. J Pediatr Surg 2022; 57 (11) 492-500
    CrossrefPubMedGoogle Scholar