Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units.
BACKGROUND
Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants.


METHODS
A prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis.


RESULTS
A total of 2208 (51.6%) infants received RBC transfusions (variation per neonatal unit: 34.1% to 66.4%). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born.


CONCLUSIONS
The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.
Universidade Federal de São Paulo, São Paulo, SP, Brazil. ameliamiyashiro@yahoo.com.br.
Amelia Miyashiro Nunes
AM
dos Santos
Universidade Federal de São Paulo, São Paulo, SP, Brazil. ruthgbr@netpoint.com.br.
Ruth
R
Guinsburg
Universidade Federal de São Paulo, São Paulo, SP, Brazil. fernandaalmeida@uol.com.br.
Maria Fernanda Branco
MF
de Almeida
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. rprocianoy@gmail.com.
Renato Soibelman
RS
Procianoy
Universidade Estadual de Campinas, Campinas, SP, Brazil. sergiomarba@yahoo.com.br.
Sergio Tadeu Martins
ST
Marba
Universidade de São Paulo, Ribeirão Preto, SP, Brazil. walusa@fmrp.usp.br.
Walusa Assad Gonçalves
WA
Ferri
Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil. ligiasr@fmb.unesp.br.
Ligia MariaSuppo de Souza
LM
Rugolo
Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira - Fundação Oswaldo Cruz, Avenida Rui Barbosa, 716, Rio de Janeiro, RJ, CEP 22420040, Brazil. jlopesma@perinatal.com.br.
José Maria Andrade
JM
Lopes
Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira - Fundação Oswaldo Cruz, Avenida Rui Barbosa, 716, Rio de Janeiro, RJ, CEP 22420040, Brazil. bebethiff@gmail.com.
Maria Elisabeth Lopes
ME
Moreira
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil. jluz@pucrs.br.
Jorge Hecker
JH
Luz
Universidade Estadual de Londrina, Londrina, PR, Brazil. mrafaelacg@uol.com.br.
Maria Rafaela Conde
MR
González
Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil. jucille.meneses@gmail.com.
Jucille do Amaral
Jdo A
Meneses
Universidade Federal do Paraná, Curitiba, PR, Brazil. reginavcs@uol.com.br.
Regina Vieira Cavalcante
RV
da Silva
Universidade Federal de Uberlândia, Belo Horizonte, MG, Brazil. vosabdallah@hotmail.com.
Vânia Olivetti Steffen
VO
Abdallah
Universidade do Estado de Rio de Janeiro, Rio de Janeiro, RJ, Brazil. jlduarte@centroin.com.br.
José Luiz Muniz Bandeira
JL
Duarte
Universidade Federal do Maranhão, São Luís, MA, Brazil. patricia_marquesf@hotmail.com.
Patricia Franco
PF
Marques
Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. albertinarego@gmail.com.
Maria Albertina Santiago
MA
Rego
Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil. naf.junia@netland.com.br.
Navantino
N
Alves Filho
Universidade de São Paulo, São Paulo, SP, Brazil. verakrebs@uol.com.br.
Vera Lúcia Jornada
VL
Krebs
D000751:Anemia, Neonatal / Q000628:therapy*; D001938:Brazil; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index