title: The impact of leukoreduced red blood cell transfusion on mortality of neonates undergoing extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Blood products containing leukocytes have been associated with negative immunomodulatory and infectious effects. Transfusion-related acute lung injury is partially explained by leucocyte agglutination. The Food and Drug Administration has therefore recommended leukoreduction strategies for blood product transfusion. Our institution has been using leukocyte-reduced blood via filtration for neonates on Extracorporeal Membrane Oxygenation (ECMO). We hypothesized that the use of leukocyte-reduced blood would decrease mortality and morbidity of neonatal ECMO patients.
  
  
  METHODS
  Retrospective review of noncardiac ECMO in neonates from 1984-2011, stratified into year groups I and II (≤1996 and ≥1997). Demographics, duration and type of ECMO, complications, and outcome data were collected. Blood product use data was collected. Univariate, bivariate, and multivariate analyses determined predictors of risk-adjusted mortality by year group.
  
  
  RESULTS
  Patients (827) underwent ECMO with 65.3% (540) in group I. Overall median blood product use in mL/kg/d was 36.2 packed red blood cells (pRBC), 8.1 platelets, and 0 cyroprecipitate and/or fresh-frozen plasma. Overall mortality was 16.4%. Median pRBC used or transfused was 42.1 mL/kg/d in group I versus 19.1 mL/kg/d group II (P <0.001). On bivariate analysis, there was no difference in crude mortality between the 2 year groups (17.2% versus 16.0%, P = 0.66). However, on multivariate analysis adjusting for demographics, diagnosis, complications, and blood product use other than pRBCs, each additional transfusion of 10 mL/kg/d of pRBC was associated with a 33% increase in mortality in group I (P <0.05). Group II also showed an increase in mortality with each additional transfusion (21%) but this was not statistically significant (P = 0.07). Days on ECMO were not associated with pRBC transfusion in group I but increased in group II (additional 3 d for each 10 mL/kg/d transfused). There was no difference in infectious complications between groups I and II.
  
  
  CONCLUSIONS
  Blood transfusion requirement has diminished in newborns undergoing ECMO at our institution. Transfusion of non leukocyte-reduced blood is associated with an increase in mortality whereas transfusion of leukocyte-reduced blood provided no benefit with a trend toward increased mortality. Further research is recommended to understand these trends.
authors.affiliation: Department of Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
authors.forename: Hope T
authors.initials: HT
authors.lastname: Jackson
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, District of Columbia.
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.affiliation: Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Department of the Health Management, Merrick School of Business, University of Baltimore, Baltimore Maryland.
authors.forename: Aderonke O
authors.initials: AO
authors.lastname: Oyetunji
authors.affiliation: Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia.
authors.forename: Miller
authors.initials: M
authors.lastname: Hamrick
authors.affiliation: Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Nadler
authors.affiliation: Department of Laboratory Medicine, Children's National Medical Center, Washington, District of Columbia.
authors.forename: Edward
authors.initials: E
authors.lastname: Wong
authors.affiliation: Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia. Electronic address: fqureshi@childrensnational.org.
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Qureshi
mesh_terms: D017707:Erythrocyte Transfusion / Q000379:methods* / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D065627:Familial Primary Pulmonary Hypertension / Q000401:mortality / Q000628:therapy; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods / Q000706:statistics & numerical data; D047589:Leukocyte Reduction Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000401:mortality / Q000628:therapy; D009017:Morbidity; D012189:Retrospective Studies