Association between Red Blood Cell Transfusion and Bronchopulmonary Dysplasia in Preterm Infants

Abstract

Anemia and the need for transfusion of packed red blood cells (PRBCs) are common in preterm infants. PRBC transfusion increases the oxygen carrying capacity of hemoglobin and may result in higher rates of organ dysfunction. To determine whether PRBC transfusion in preterm infants is associated with an increased incidence of bronchopulmonary dysplasia (BPD), this retrospective study was performed on neonates with birth weights ≤ 1,500 g or gestational age ≤ 32 weeks admitted from August, 2008 to November, 2013. Infants who received PRBC transfusion before the diagnosis of BPD and those who did not receive PRBC transfusion or received PRBC transfusion after diagnosis of BPD were compared for incidence of BPD and other morbidities. Of 231 preterm infants, 137 received PRBC transfusion before BPD was diagnosed (group 1) and 94 did not (group 2). The incidence of BPD was significantly higher in group 1 than in group 2 (37.2% vs. 2.1%, P < 0.00001). After adjusting for potential risk factors, the adjusted odds ratio for BPD was 9.80 (95% confidence interval, 1.70–56.36; P = 0.01). This study demonstrated an association between PRBC transfusion and BPD in preterm infants. A cautious approach to PRBC transfusion in these infants is warranted.

Enteral iron supplementation, red blood cell transfusion, and risk of bronchopulmonary dysplasia in very‐low‐birth‐weight infants

“…We found an association between a greater total volume of RBCs transfused and higher risk of BPD. This finding has been previously reported in prior observational studies, including a prospective observational study in the United Kingdom and more recent single‐center observational studies from China . A study from Korea found similar associations between volume and number of RBC transfusions and BPD in a univariable analysis, but no association with ferritin levels or average iron supplementation during hospitalization and BPD .…”

“…This finding has been previously reported in prior observational studies, including a prospective observational study in the United Kingdom 24 and more recent single-center observational studies from China. 7,25 A study from Korea found similar associations between volume and number of RBC transfusions and BPD in a univariable analysis, but no association with ferritin levels or average iron supplementation during hospitalization and BPD. 26 By contrast, a recent prospective study from Japan found hyperferritinemia (ferritin ≥500 ng/mL) to be associated with a higher risk of BPD.…”

“…Although short‐term exposure to high doses of iron have not been associated with oxidative stress, the cumulative chronic exposure to both enteral iron supplementation and RBC transfusions may potentially place infants at risk for iron overload . Several reports have shown an association between RBC transfusion and a higher risk of BPD, although it is unclear whether the risk is due to the transfusion itself or the likelihood that infants who have worse respiratory disease receive more RBC transfusions. The mechanistic role of iron and oxidative stress in the development of BPD has been postulated, although no clear relationship has been identified .…”

Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants

“…Exposure to prolonged anemia may have detrimental consequences on the preterm infant, contributing to complications related to prematurity and poor growth . Conversely, RBC transfusions are not without risks, including potential associations with necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, and adverse long‐term neurodevelopmental outcomes . Randomized controlled trial data have shown conflicting results between a liberal (higher hematocrit [Hct] threshold) versus a restrictive (lower Hct threshold) transfusion strategy with regard to short‐term morbidities and long‐term neurodevelopmental outcomes .…”

“…1 Conversely, RBC transfusions are not without risks, including potential associations with necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, and adverse long-term neurodevelopmental outcomes. 1,[6][7][8][9][10][11] Randomized controlled trial data have shown conflicting results between a liberal (higher hematocrit [Hct] threshold) versus a restrictive (lower Hct threshold) transfusion strategy with regard to short-term morbidities and long-term neurodevelopmental outcomes. 3,12 Not surprisingly, transfusion practices vary greatly given the lack of clear evidence to guide transfusion strategy.…”