title: Red blood cell transfusion in critically ill children is independently associated with increased mortality.
abstract: OBJECTIVE
  To test the hypothesis that RBC transfusion in critically ill children is independently associated with increased mortality and morbidity.
  
  
  METHODS
  Retrospective, descriptive epidemiologic cohort study.
  
  
  METHODS
  Single-center experience of a nine-bed pediatric intensive care unit (PICU) facility.
  
  
  METHODS
  Critically ill children without ongoing active blood loss aged 0[Symbol: see text]months to 18[Symbol: see text]years, excluding prematurely born infants or patients after cardiothoracic surgery, and patients with chronic anemia.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data of 295 consecutive patients was studied. Of these patients, 13.4% had a Hb concentration less than 9.6 g/dl. Sixty-seven (22.7%) of all patients were transfused, 39 only once. Transfused patients had a higher mortality (16.4 vs. 2.6%, p < 0.001). Mortality seemed related to the number of transfusion (p = 0.002) rather than the pre-transfusion Hb concentration (p = 0.10). Transfused patients required prolonged ventilatory support (11.1 +/- 1.8 vs. +/- 0.3 days, p < 0.001), infusion of vaso-active agents (8.2 +/- 1.8 vs. 2.8 +/- 0.6 days, p < 0.001) and PICU stay (13.0 +/- 1.8 vs. 3.2 +/- 0.2 days, p < 0.001). After multivariate analysis adjusting for age, PIM probability of death, mean TISS-28 score during the first 48 h, post-operative admission, diagnosis of sepsis or trauma or malignancy, pre-transfusion Hb concentration, and RBC transfusion remained independently associated with mortality and morbidity.
  
  
  CONCLUSIONS
  RBC transfusion in critically ill children is independently associated with increased mortality and prolonged duration of mechanical ventilation, prolonged infusion of vaso-active agents and prolonged PICU stay.
authors.affiliation: Department of Pediatric Intensive Care, Office 8 D 12, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. m.kneyber@vumc.nl
authors.forename: Martin C J
authors.initials: MC
authors.lastname: Kneyber
authors.forename: Mohammed I
authors.initials: MI
authors.lastname: Hersi
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: Dick G
authors.initials: DG
authors.lastname: Markhorst
authors.forename: Frans B
authors.initials: FB
authors.lastname: Plötz
mesh_terms: D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D019370:Observation; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies