Post transfusion lung injury in the neonatal population

Rashid, Nazia; Al-Sufayan, F; Seshia, Molly; Baier, R J

doi:10.1038/jp.2012.114

Cited by 41 publications

(35 citation statements)

References 33 publications

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“…There is growing recognition of the significant contribution of inflammation and oxidative stress to the pathogenesis of BPD, processes similar to those seen with TRALI . While rates of post‐transfusion lung injury is reported to be as high as 10% in preterm neonates, failure to take into account very high rates of respiratory instability in this population limits the interpretation of these data . A retrospective study of 108 newborns transfused a total of 373 times reported a rate of post‐transfusion respiratory deterioration in 8.3% .…”

Section: Transfusion and Neonatal Morbiditymentioning

confidence: 99%

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

Crawford

Andersen

Hodyl

et al. 2019

J Paediatrics Child Health

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Anaemia of prematurity will affect 90% of all very preterm infants, resulting in at least one red blood cell (RBC) transfusion. A significant proportion of preterm infants require multiple transfusions over the course of hospital admission. Growing evidence supports an association between transfusion exposure and adverse neonatal outcomes. In adults, transfusion‐associated sepsis, transfusion‐related acute lung injury and haemolytic reactions are the leading causes of transfusion‐related morbidity and mortality; however, these are seldom recognised in newborns. The association between transfusion and adverse outcomes remains inconclusive. However, the evidence from preclinical studies demonstrates that RBC products can directly modulate immune cell function, a pathway termed transfusion‐related immunomodulation (TRIM), which may provide a mechanism linking transfusion exposure with neonatal morbidities. Finally, we discuss the impact of TRIM on transfusion medicine, how we may address these issues and the emerging areas of research aimed at improving the safety of transfusions in this vulnerable population.

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Section: Transfusion and Neonatal Morbiditymentioning

confidence: 99%

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

Crawford

Andersen

Hodyl

et al. 2019

J Paediatrics Child Health

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“…There were five paediatric reports classified as transfusion-associated circulatory overload (TACO) that included one neonate. It seems likely that there is under-recognition and/or under-reporting of transfusion-related adverse events in neonates [6,7] due to pre-existing critical illness, in particular around the recognition of TRALI [8] as many preterm neonates having intercurrent respiratory disease. This is compounded by the difficulties in defining adverse transfusion events in a neonatal setting.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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

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“…In addition, it was not possible to collect detailed information on potential adverse effects related to fluid bolus beyond 6 h, such as volume overload, dilutional coagulopathy, hypothermia and electrolyte disturbances . This lack of data extends to other specific fluid‐related complications, including transfusion reactions or 0.9% sodium chloride‐induced hypochloremic metabolic acidosis, although we did not observe any significant increase in chloride‐level post‐fluid bolus. We did not observe any significant changes in measured laboratory indices post‐bolus.…”

Section: Discussionmentioning

confidence: 99%

International, multicentre, observational study of fluid bolus therapy in neonates

Keir

Karam

Hodyl

et al. 2018

J Paediatrics Child Health

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Aim To assess the prevalence, types and indications for fluid bolus therapy in neonates with haemodynamic compromise. Methods This was a pragmatic, international, multicentre observational study in neonatal units across Australasia, Europe and North America with a predefined study period of 10–15 study days per participating neonatal unit between December 2015 and March 2017. Infants ≤28 days of age who received a fluid bolus for the management of haemodynamic compromise (≥10 mL/kg given at ≤6 h) were included. Results A total of 163 neonates received a bolus over 8479 eligible patient days in 41 neonatal units. Prevalence of fluid bolus therapy varied between centres from 0 to 28.6% of admitted neonates per day, with a pooled prevalence rate of 1.5% (95% confidence interval 1.1–1.9%). The most common fluid used was 0.9% sodium chloride (129/163; 79%), and the volume of fluid administered was most commonly 10 mL/kg (115/163; 71%) over a median of 30 min (interquartile range 20–60). The most frequent indications were hypotension (n = 56; 34%), poor perfusion (n = 20; 12%) and metabolic acidosis (n = 20; 12%). Minimal or no clinical improvement was reported by clinicians in 66 of 163 cases (40%). Conclusions Wide international variations in types, indications and effects of fluid bolus administration in haemodynamically compromised neonates suggest uncertainty in the risk–benefit profile. This is likely to reflect the lack of robust evidence to support the efficacy of different fluid types, doses and appropriate indications. Together, these highlight a need for further clinically relevant studies.

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Post transfusion lung injury in the neonatal population

Abstract: In neonates receiving intensive or intermediate care, blood transfusion was associated with need for increased respiratory support in a significant number of cases. Development of NPTLI was associated with poorer outcomes.

Cited by 41 publications

References 33 publications

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

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

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

International, multicentre, observational study of fluid bolus therapy in neonates

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