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.
Bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) all likely involve oxidative damage to immature tissues. It has been postulated that transfusions of adult erythrocytes contribute to the risk of developing these morbidities, as a consequence of adult hemoglobin releasing non-physiological quantities of O₂ to developing tissues. In 2009, we instituted a concerted effort to diminish erythrocyte transfusions in our NICU, and in 2013 we performed a before vs. after practice change analysis of the incidence of BPD, ROP and NEC during the 8-year period spanning this change. The transfusion rate fell from a high of 14.8% of admissions in 2007 to a low of 6.3% in 2011 (p < 0.001). Concordant with this reduction patients had a lower incidence of; BPD (from 3.2% to 0.9%; OR, 3.722; CI 1.897-7.302), ROP (from 4.6% to 2.4%; OR 1.958, CI 1.247-3.073), and a trend toward less NEC (from 0.7% to 0.2%; OR 3.090, CI 0.835-11.443).
Division of Neonatology, Neonatal Intensive Care Unit, Di Venere Hospital , Bari , Italy .
Antonio
A
Del Vecchio
Erick
E
Henry
Gabriele
G
D'Amato
Annamaria
A
Cannuscio
Luigi
L
Corriero
Mario
M
Motta
Robert D
RD
Christensen
D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology* / Q000209:etiology; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology* / Q000209:etiology; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006284:Health Plan Implementation; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards; D007558:Italy; D012178:Retinopathy of Prematurity / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies