title: Among very-low-birth-weight neonates is red blood cell transfusion an independent risk factor for subsequently developing a severe intraventricular hemorrhage?
abstract: BACKGROUND
  A severe intraventricular hemorrhage (IVH) in a preterm neonate can result in life-long disabilities or death. Pathogenic mechanisms responsible for IVH are incompletely understood. We postulated that if the timing of a severe IVH could be approximated by serial ultrasound, potentially relevant antecedents could be identified.
  
  
  METHODS
  We retrospectively identified all very-low-birth-weight (VLBW) neonates in our health system, over a 5-year period, with an initial head ultrasound showing no hemorrhage but a subsequent ultrasound showing a Grade 3 or 4. Controls that did not develop an IVH were matched with cases using demographic features and degree of illness measures.
  
  
  RESULTS
  Fifty-four cases were matched (1:2) with controls. No differences were found between cases and controls in initial pH, sepsis, ventilation, coagulation studies, or proportion with severe thrombocytopenia. However, during the period when the head ultrasound was normal, cases were more likely to have had a red blood cell (RBC) transfusion (p < 0.001). In 94% of the cases the sequence was 1) no IVH, 2) RBC transfusion, and 3) severe IVH. With the use of logistic regression, each subsequent RBC transfusion during the first week was determined to double the risk of a severe IVH (each transfusion increases relative risk, 2.02; 95% confidence interval, 1.54-3.33). Sensitivity analysis indicated a high likelihood that RBC transfusion, independent of hemoglobin level or other factors, increases the risk of developing a severe IVH.
  
  
  CONCLUSIONS
  These findings suggest a new hypothesis. Namely, RBC transfusions given before the development of an IVH are an independent risk factor for developing a severe IVH.
authors.affiliation: Department of Women and Newborns, Intermountain Healthcare, McKay-Dee Hospital Center, Ogden, Utah 84403, USA.
authors.forename: Vickie L
authors.initials: VL
authors.lastname: Baer
authors.forename: Diane K
authors.initials: DK
authors.lastname: Lambert
authors.forename: Erick
authors.initials: E
authors.lastname: Henry
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Snow
authors.forename: Allison
authors.initials: A
authors.lastname: Butler
authors.forename: Robert D
authors.initials: RD
authors.lastname: Christensen
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D012189:Retrospective Studies