title: Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units.
abstract: BACKGROUND
  Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants.
  
  
  METHODS
  RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis.
  
  
  RESULTS
  Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001).
  
  
  CONCLUSIONS
  The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.
authors.affiliation: Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil. ameliamiyashiro@yahoo.com.br
authors.forename: Amélia M N
authors.initials: AM
authors.lastname: dos Santos
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
authors.forename: Renato S
authors.initials: RS
authors.lastname: Procianoy
authors.forename: Lílian dos S R
authors.initials: Ldos S
authors.lastname: Sadeck
authors.forename: Abimael Aranha
authors.initials: AA
authors.lastname: Netto
authors.forename: Ligia M
authors.initials: LM
authors.lastname: Rugolo
authors.forename: Jorge H
authors.initials: JH
authors.lastname: Luz
authors.forename: Olga
authors.initials: O
authors.lastname: Bomfim
authors.forename: Francisco E
authors.initials: FE
authors.lastname: Martinez
authors.forename: Maria Fernanda B
authors.initials: MF
authors.lastname: de Almeida
mesh_terms: D001034:Apgar Score; D001938:Brazil / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000628:therapy*; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011247:Pregnancy