Adverse effects of red blood cell transfusions in neonates: a systematic review and meta‐analysis

Abstract

Statistically significant differences in a range of harmful outcomes between neonates exposed to restrictive and liberal RBC transfusion practice were not found. However, the risks of bias identified in many studies and the lack of consistent reporting and definitions of events limits our conclusions.

The contribution of red blood cell transfusion to neonatal morbidity and mortality

“…Similarly, in a cohort study of ELBW newborns, the number of RBC transfusions in the first 7 days of life correlated with mortality before 1 month of age . However, a recent meta‐analysis of the adverse outcomes potentially associated with RBC transfusion exposure, particularly rates of mortality associated with restrictive versus liberal transfusion strategies, found no difference in mortality …”

“…Extremely premature newborns are susceptible to numerous potentially fatal or severely disabling conditions, including necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) and intraventricular haemorrhage (IVH). While a number of observational studies have raised the possibility of an association between RBC transfusion and adverse neonatal outcome, controversy remains about the contribution of transfusion exposure to their pathophysiology …”

“…A retrospective study of 108 newborns transfused a total of 373 times reported a rate of post‐transfusion respiratory deterioration in 8.3% . However, a meta‐analysis of randomised trials comparing restrictive versus liberal transfusion thresholds fails to demonstrate increased incidence of chronic lung disease, with greater transfusion exposure . Both observational and randomised studies are limited by the lack of an accepted definition of TRALI in the preterm newborn and the difficulty in differentiating the contribution of underlying lung pathology versus a transfusion‐related effect.…”

“…However, this study is confounded by high attrition rate overall, variability in haematocrit in the liberal transfusion arm and a very small sample size for a study with a clinical outcome. Nonetheless, as seen for BPD, a meta‐analysis of randomised trials comparing restrictive versus liberal transfusion thresholds fails to demonstrate increased incidence of ROP, with greater transfusion exposure …”

“…The most recent systematic review investigated clinical adverse effects and associations attributable to RBC exposure in the preterm newborn, including 61 randomised and non‐randomised trials . Authors concluded that there was no evidence that mortality risk was greater between liberal or restrictive transfusion thresholds.…”