Objectives-To determine the risks and benefits associated with the transfusion of packed red blood cells (PRBCs) in extremely low birth weight (ELBW) infants. We hypothesized that when ELBW infants underwent transfusion with the University of Washington Neonatal Intensive Care Unit (NICU) 2006 guidelines, no clinical benefit would be discernible.Study design-We conducted a retrospective chart review of all ELBW infants admitted to the NICU in 2006. Information on weight gain, apnea, heart rate, and respiratory support was collected for 2 days preceding, the day of, and 3 days after PRBC transfusion. The incidence, timing, and severity of complications of prematurity were documented.Results-Of the 60 ELBW infants admitted to the NICU in 2006, 78% received PRBC transfusions. Transfusions were not associated with improved weight gain, apnea, or ventilatory/ oxygen needs. However, they were associated with increased risk of bronchopulmonary dysplasia, necrotizing enterocolitis, and diuretic use (P < .05). Transfusions correlated with phlebotomy losses, gestational age, and birth weight. No association was found between transfusions and sepsis, retinopathy of prematurity, or erythropoietin use.Conclusions-When our 2006 PRBC transfusion guidelines were used, no identifiable clinical benefits were identified, but increased complications of prematurity were noted. New, more restrictive guidelines were developed as a result of this study.Preterm infants are among the most highly transfused patient populations. The most common rationale for transfusing with packed red blood cells (PRBCs) in preterm infants is to improve oxygen delivery. However, there is little evidence that oxygen delivery is compromised at commonly used transfusion triggers. [1][2][3][4] Transfusion guidelines became common in neonatal intensive care units (NICUs) after several clinical erythropoietin (EPO) trials showed that the institution of guidelines alone helped to decrease the frequency of transfusions in preterm infants. 5 These transfusion guidelines are based on expert opinion, rather than evidence-based, and therefore vary from hospital to hospital, with some units favoring restrictive guidelines and others more liberal guidelines. 2,3 Many symptoms have been attributed to chronic anemia in preterm infants including tachycardia, poor weight gain, apnea, and lactic acidosis, but there is no definitive evidence that when using any current guidelines, transfusion of PRBCs results in clinical benefit. Earlier studies show contradictory results about whether transfusions improve [6][7][8][9][10][11] or weight gain 12,13 in preterm infants, but none focus specifically on extremely low birth weight (ELBW) infants.There is increasing awareness that transfusion of blood products is not benign. In adults, anemia is an independent risk factor for increased cardiac and surgical morbidity and mortality, but correction of anemia with transfusion does not ameliorate this risk.Transfusion is an independent predictor of death, with an associated incr...

Critically ill newborn infants experience stressors that may alter brain development. Using a rodent model, we previously showed that neonatal stress, morphine, and stress plus morphine treatments each influence early gene expression and may impair neurodevelopment and learning behavior. We hypothesized that the combination of neonatal stress with morphine may alter neonatal angiogenesis and/or adult cerebral blood vessel density and thus increase injury after cerebral ischemia in adulthood. To test this, neonatal Lewis rats underwent 8 h/d maternal separation, plus morning/afternoon hypoxia exposure and either saline or morphine treatment (2 mg/kg s.c.) from postnatal day 3 to 7. A subset received bromodeoxyuridine to track angiogenesis. Adult brains were stained with collagen IV to quantify cerebral blood vessel density. To examine vulnerability to brain injury, postnatal day 80 adult rats underwent right middle cerebral artery occlusion (MCAO) to produce unilateral ischemic lesions. Brains were removed and processed for histology 48 hours after injury. Brain injury was assessed by histological evaluation of hematoxylin and eosin, and silver staining. In contrast to our hypothesis, neither neonatal morphine, stress, nor the combination affected cerebral vessel density or MCAO-induced brain injury. Neonatal angiogenesis was not detected in adult rats possibly due to turnover of endothelial cells. Although unrelated to angiogenesis, hippocampal granule cell neurogenesis was detected and there was a trend (P = 0.073) toward increased bromodeoxyuridine incorporation in rats that underwent neonatal stress. These findings are discussed in contrast to other data concerning the effects of morphine on cerebrovascular function, and acute effects of morphine on hippocampal neurogenesis.