title: Packed red blood cell transfusions as a risk factor for parenteral nutrition associated liver disease in premature infants.
abstract: OBJECTIVE
  To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease.
  
  
  METHODS
  A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell (PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin (db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells (the median value). Kaplan-Meier plots estimated the median volume of packed red blood cells received in order to develop parenteral nutrition associated liver disease.
  
  
  RESULTS
  Parenteral nutritional associated liver disease (PNALD) was noted in 21 (43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17 (64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.
  
  
  CONCLUSIONS
  In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.
authors.affiliation: Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
authors.forename: Antoni
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
authors.forename: Anushree
authors.initials: A
authors.lastname: Algotar
authors.affiliation: Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
authors.forename: Ling
authors.initials: L
authors.lastname: Pan
authors.affiliation: Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Schwarz
authors.affiliation: Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
authors.forename: William R
authors.initials: WR
authors.lastname: Treem
authors.affiliation: Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
authors.forename: Gloria
authors.initials: G
authors.lastname: Valencia
authors.affiliation: Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
authors.forename: Simon S
authors.initials: SS
authors.lastname: Rabinowitz
keywords: Neonatal intensive care unit; Packed red blood cell transfusion; Parenteral nutrition associated liver disease