Complications Associated with Red Blood Cell (RBC) Transfusions in the Very Low Birth Weight (VLBW) Infant

Background: Both prematurity and transfusions predispose to compromised outcome in very low birth weight infants. Methods: We retrospectively examined correlations of outcome with frequency of RBC transfusions and age of blood transfused to VLBW infants admitted to a level III neonatal intensive care unit between January 1st, and December 31st, 2008. Short and long term outcome data of the transfused were compared with the non-transfused. Correlation coefficient and multivariate analysis were applied for correlations within the transfused group. Significance was assessed at p<0.05. Results: Of 189 VLBW infants identified; 106 (56%) received a mean 7.9±7.8 (median 5) transfusions/infant, with a mean volume of 147±183 (median 94) ml/infant. Transfused VLBW infants compared to those non-transfused had lower gestational age (GA), higher number of ventilator and length of stay (LOS) days. They also had higher incidence of intraventricular haemorrhage (IVH)>grade 2(14.9% vs3.2%), retinopathy of prematurity (ROP)>stage 2(15.2% vs 0%), Sepsis (30.8% vs 4.9%, p.001), and mortality (15.1% vs 3.6%, p.009). There were 25 cases of necrotizing enterocolitis (NEC), 19 of them (76%) were preceded by transfusions within 72 hours. Leukocytosis (p.o42) with relative granulocytosis (p.012) was seen at 24 hours, and lymphopenia (p.035) at 12 hours post transfusion. Multivariate regression analysis adjusting for GA, showed that frequent transfusions were associated with sepsis, ROP>stage II and IVH> grade II (OR 1.136, 1.056 and 1.036 respectively, p.001). RBCs older than 14 days were associated with longer LOS (p.001) but no significant adverse associations seen on the multivariate analysis. Conclusion: Transfusions are frequent in the VLBW infants and were associated with sepsis and post-transfusion NEC. Higher frequency of transfusions was associated with sepsis, severe ROP and IVH, while Older RBCs had no ill associations when adjusting for GA. Post-transfusion changes in white cell count and its subgroups may suggest inflammation and/or immunomodulation that warrant further investigation.