title: Red blood cell transfusions are independently associated with intra-hospital mortality in very low birth weight preterm infants.
abstract: OBJECTIVE
  To test the hypothesis that red blood cell (RBC) transfusions in preterm infants are associated with increased intra-hospital mortality.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Transfusion was associated with increased death, and transfusion guidelines should consider risks and benefits of transfusion.
authors.affiliation: Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. ameliamiyashiro@yahoo.com.br
authors.forename: Amélia Miyashiro Nunes
authors.initials: AM
authors.lastname: dos Santos
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
authors.forename: Maria Fernanda Branco
authors.initials: MF
authors.lastname: de Almeida
authors.forename: Renato S
authors.initials: RS
authors.lastname: Procianoy
authors.forename: Cléa Rodrigues
authors.initials: CR
authors.lastname: Leone
authors.forename: Sérgio Tadeu Martins
authors.initials: ST
authors.lastname: Marba
authors.forename: Ligia Maria Suppo de Souza
authors.initials: LM
authors.lastname: Rugolo
authors.forename: Humberto Holmer
authors.initials: HH
authors.lastname: Fiori
authors.forename: José Maria de Andrade
authors.initials: JM
authors.lastname: Lopes
authors.forename: Francisco Eulógio
authors.initials: FE
authors.lastname: Martinez
mesh_terms: D001938:Brazil / Q000453:epidemiology; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D011446:Prospective Studies; D012044:Regression Analysis; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D018805:Sepsis / Q000453:epidemiology