Adverse effects of small-volume red blood cell transfusions in the neonatal population

Abstract

BackgroundAdverse transfusion reactions in the neonatal population are poorly understood and defined. The incidence and pattern of adverse effects due to red blood cell (RBC) transfusion are not well known, and there has been no systematic review of published adverse events. RBC transfusions continue to be linked to the development of morbidities unique to neonates, including chronic lung disease, retinopathy of prematurity, intraventricular haemorrhage and necrotising enterocolitis. Uncertainties about the exact nature of risks alongside benefits of RBC transfusion may contribute to evidence of widespread variation in neonatal RBC transfusion practice.Our review aims to describe clinical adverse effects attributed to small-volume (10–20 mL/kg) RBC transfusions and, where possible, their incidence rates in the neonatal population through the systematic identification of all relevant studies.MethodsA comprehensive search of the following bibliographic databases will be performed: MEDLINE (PubMed/OVID which includes the Cochrane Library) and EMBASE (OVID). The intervention of interest is small-volume (10–20 mL/kg) RBC transfusions in the neonatal population.We will undertake a narrative synthesis of the evidence. If clinical similarity and data quantity and quality permit, we will also carry out meta-analyses on the listed outcomes.DiscussionThis systematic review will identify and synthesise the reported adverse effects and associations of RBC transfusions in the neonatal population. We believe that this systematic review is timely and will make a valuable contribution to highlight an existing research gap.Trial RegistrationPROSPERO, CRD42013005107http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005107

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

“…This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement . A full version of the review protocol has been published; therefore, only a summary of the review protocol is provided here.…”

Alterations in Serum Lead Levels Following Packed Red Blood Cells Transfusions to Preterms Admitted to Neonatal Intensive Care Unit at Cairo University Pediatric Hospital

“…One important aspect of the LBW infant's physiology is the occurrence of oxidative stress and hypocalcemia. Both can potentiate lead deposition and exacerbate its potential toxicity especially to the growing brain and skeletal system (9,14). Multivariate analysis revealed that blood creatinine level after transfusion was the best predictor of BLL% change.…”

“…(i) Complications during NICU stay (9). (ii) Mortality: either mortality associated with receipt of PRBCs transfusion (within 24 -48 hours of receipt of a transfusion), which may be related to initial pathology or mortality before discharge from initial diagnosis or complications.…”

Do feeding practices during transfusion influence the risk of developing necrotising enterocolitis in preterm infants?

“…Over recent years, the association between the receipt of an RBC transfusion and development of NEC within the following 48 h has been well described and has been coined TANEC . However, systematic reviews examining whether primary studies support this association have arrived at conflicting conclusions . Despite this, potential interventions to decrease the risk of this potential entity have been explored, including withholding enteral feeds during transfusion.…”

“…5 However, systematic reviews examining whether primary studies support this association have arrived at conflicting conclusions. [5][6][7] Despite this, potential interventions to decrease the risk of this potential entity have been explored, including withholding enteral feeds during transfusion. As a consequence, there are reported clinical variations in clinical practices around continuing, reducing or withholding enteral feeds during neonatal transfusion.…”