title: Red Blood Cell Transfusion and Clinical Outcomes in Extremely Low Birth Weight Preterm Infants.
abstract: Red blood cell (RBC) transfusion is often considered a life-saving measure in critically ill neonates. The smallest and least mature infants tend to receive the largest amount of transfusions. RBC transfusion itself has also been suggested as an independent risk factor of poor clinical outcome in critical patients. Our aim is to study if there are associations between RBC transfusion and in-hospital mortality, short-term morbidities, and late neurodevelopmental outcome in extremely low birth weight (ELBW) preterm infants.
  
  
  
  A cohort of ELBW preterm infants admitted to our neonatal intensive care unit from January 2009 to December 2010 were recruited. The number of RBC transfusions within 7 days, 30 days, and 60 days of life were recorded. Clinical outcomes including in-hospital mortality, development of retinopathy of prematurity (ROP), necrotizing enterocolitis, chronic lung disease, and later neurodevelopmental outcome were assessed with follow-up of up to 2 years of age. Multivariable logistic regression was used to estimate the associations between RBC transfusion and clinical outcomes.
  
  
  
  A total of 98 ELBW preterm infants survived at the time of discharge. Of these survivors, the mean numbers of RBC transfusions were 2.5 ± 1.7, 7.4 ± 3.1, and 11.3 ± 4.5 times within 7 days, 30 days, and 60 days after birth, respectively. The number of transfusions within 7 days of life was correlated with risk of death before 1 month of age (odds ratio: 1.54, 95% confidence interval: 1.04-2.27, p = 0.03) and the number of transfusions within 30 days was correlated with risk of developing threshold ROP (odds ratio: 1.27, 95% confidence interval: 1.04-1.55, p = 0.02). The number of transfusions within 7 days of life was positively correlated with cognitive performance (Mental Developmental Index score) at 18-24 months of corrected age.
  
  
  
  RBC transfusion has a negative impact on survival in ELBW infants. It increases the risk of developing ROP and affects late neurodevelopment. Decisions of blood transfusion in these very immature infants should be made cautiously taking these deleterious results into consideration.
authors: Department of Pediatrics, Ton-Yen General Hospital, Hsinchu, Taiwan.
authors: Yu-Cheng
authors: YC
authors: Wang
authors: Division of Neonatology, Department of Pediatrics, Chang-Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Oi-Wa
authors: OW
authors: Chan
authors: Division of Neonatology, Department of Pediatrics, Chang-Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ming-Chou
authors: MC
authors: Chiang
authors: Division of Neonatology, Department of Pediatrics, Chang-Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Peng-Hong
authors: PH
authors: Yang
authors: Division of Neonatology, Department of Pediatrics, Chang-Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Shih-Ming
authors: SM
authors: Chu
authors: Division of Neonatology, Department of Pediatrics, Chang-Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Jen-Fu
authors: JF
authors: Hsu
authors: Division of Neonatology, Department of Pediatrics, Chang-Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ren-Huei
authors: RH
authors: Fu
authors: Division of Neonatology, Department of Pediatrics, Chang-Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: reyinl@cgmh.org.tw.
authors: Reyin
authors: R
authors: Lien
mesh_terms: D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors
keywords: RBC transfusion; extremely low birth weight; mortality; neurodevelopmental outcome; preterm infants