Association between red blood cell transfusion and bronchopulmonary dysplasia: a systematic review and meta-analysis

Abstract

BackgroundWe aimed to determine the association between red blood cell transfusions (RBCT) and bronchopulmonary dysplasia (BPD) in neonates.MethodsA systematic review and meta-analysis were conducted using data obtained from literature search of PubMed, Embase, and Web of Science from their inception till May 1, 2022. Two reviewers independently selected potentially relevant studies, and after data extraction, they assessed the methodological quality of the included studies using the Newcastle–Ottawa scale. Data were pooled using random-effects models in Review Manager 5.3. Subgroup-analysis was performed based on the number of transfusions and adjusted results.ResultsOf the 1,011 identified records, 21 total case-control, cross-sectional, and cohort studies were selected, which included a total of 6,567 healthy controls and 1,476 patients with BPD. The pooled unadjusted odds ratio ([OR], 4.01; 95% confidence interval [CI] 2.31–6.97) and adjusted OR (5.11; 95% CI 3.11–8.4) showed significant association between RBCT and BPD. A substantial heterogeneity was noted, which could be due to different variables controlled for in each study. The subgroup analysis showed that heterogeneity may be partially explained by the extent of transfusion.ConclusionThe association between BPD and RBCT remains unclear based on the current data due to the substantial heterogeneity among the results. Well-designed studies are still needed in the future.

Impact of level of neonatal care on phlebotomy and blood transfusion in extremely low birthweight infants: a prospective, multicenter, observational study

“…Although we adjusted for potential confounding factors, the association between transfusion and BPD remained significant. In a recent metanalysis of 21 studies, Tang et al postulated several reasons in support of the association between BPD and red cell transfusions ( 52 ). These include increased hyperoxic exposure through adult hemoglobin, inflammatory mediators in transfused blood that may enhance free radical formation, infection, and fibrosis, iron overload that stimulates oxidative stress secondary to immature iron metabolism and an inadequate antioxidant defense mechanism especially in ELBW infants and cytokine-induced lung inflammation that may result in transfusion related acute lung injury ( 19 , 53 – 57 ).…”