Red Blood Cell Transfusions are Independently Associated with Intra-Hospital Mortality in Very Low Birth Weight Preterm Infants

Santos, Amélia Miyashiro Nunes dos; Guinsburg, Ruth; Almeida, Maria Fernanda Branco de; Procianoy, Renato S.; Leone, Cléa Rodrigues; Marba, Sérgio Tadeu Martins; Rugolo, Lígia Maria Suppo de Souza; Fiori, Humberto Holmer; Lopes, José Maria de Andrade; Martinez, Francisco Eulógio

doi:10.1016/j.jpeds.2011.02.040

Cited by 114 publications

(102 citation statements)

References 28 publications

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“…There is an increasing awareness that transfusion of blood products in preterm infants is an independent predictor of adverse outcome [23,24]. The implementation of more stringent transfusion guidelines, restraint of phlebotomy losses, iron supplementation and erythropoietin administration are all recommended approaches to reduce the frequency of transfusions in these patients [1].…”

Section: Discussionmentioning

confidence: 99%

Allogeneic Umbilical Cord Blood Red Cell Concentrates: An Innovative Blood Product for Transfusion Therapy of Preterm Infants

Bianchi¹,

Giannantonio

Spartano³

et al. 2014

Neonatology

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Background: Preterm infants often receive blood transfusions early in life. In this setting, umbilical cord blood (UCB) might be safer than adult blood (A) with respect to infectious and immunologic threats. Objectives: To evaluate, as a first objective, the feasibility of fulfilling transfusion needs of preterm infants with allogeneic UCB red blood cell (RBC) concentrates and, as a secondary objective, to assess the safety of allogeneic cord blood transfusions. Methods: At the Neonatal Intensive Care Unit and the UNICATT Cord Blood Bank of ‘A. Gemelli' Hospital in Rome, a prospective study was carried out over a 1-year period, enrolling newborns with gestational age ≤30 weeks and/or birth weight ≤1,500 g requiring RBC transfusions within the first 28 days of life. At first transfusion, patients were assigned to receive UCB-RBCs or A-RBCs depending on the availability of ABO-Rh(D)-matched UCB-RBC units. The same regimen (UCB-RBC or A-RBC units) was thereafter maintained, unless ABO-Rh(D)-matched UCB-RBC units were not available. Results: Overall, 23 UCB-RBC units were transfused to 9 patients; the requests for UCB-RBC units were met in 45% of patients at the first transfusion and in 78% at the subsequent transfusions. At a median follow-up of 57 days (range 6-219), no acute or delayed transfusion-related adverse events occurred. Hematocrit gain after transfusion and time intervals between transfusions were similar in the UCB-RBC and A-RBC group, as well. Conclusions: Transfusing allogeneic UCB-RBC units in preterm infants appears a feasible and safe approach, although the transfusion needs of our study population were not completely covered. More data are necessary to validate this novel transfusion practice. © 2014 S. Karger AG, Basel

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Section: Discussionmentioning

confidence: 99%

Allogeneic Umbilical Cord Blood Red Cell Concentrates: An Innovative Blood Product for Transfusion Therapy of Preterm Infants

Bianchi¹,

Giannantonio

Spartano³

et al. 2014

Neonatology

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“…While transfusion is beneficial in the setting of acute perinatal blood losses and severe anaemia, its advantage in moderate grades of anaemia in stable preterm infants remain uncertain 1 . Blood transfusion has been reported to be an independent risk factor of mortality 2,3 and in the first weeks of life has been linked to progression of intraventricular haemorrhage 4 in preterm infants. The threshold for transfusion in preterm infants remain controversial and has led to several randomised controlled trials using liberal and restrictive thresholds for blood transfusion with conflicting reports on neurological outcomes [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Banerjee

Leung

Aladangady

2016

Early Human Development

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word count: 400 words (maximum 400) Manuscript body word count: 4057 words (maximum 6000) 2 | P a g e AbstractPreterm infants frequently receive blood transfusion during their stay in neonatal unit, and its impact on organ perfusion and oxygenation is not clear. The aim of the study was to measure the effect of blood transfusion on cerebral blood flow and oxygenation in preterm infants in relation to chronological age.Fifty nine infants were studied: group 1=20, group 2=21 and group 3=18 infants with median age (range) at transfusion of 5 (1-7), 14 (8-27) and 45 (29-68) days respectively. Gestational age and birth weight of infants between groups were similar. Pre-transfusion vital parameters were similar between the groups except the heart rate was significantly higher in group 1 compared to group 3 (p=0.02). The mean BP increased significantly in all three groups and there were no significant changes in other vital parameters following transfusion.There was no change in pre and post transfusion pCO2 and pH in blood gas. The mean pretransfusion Anterior Cerebral artery (ACA) time averaged mean velocity (TAMV) increased significantly with chronological age (p<0.001), and ACA Peak Systolic Velocity (PSV) also increased with chronological age of infants but this was not significant. Pre-transfusion ACA TAMV and PSV decreased significantly (p≤0.04), and there was no change in ACA Resistance Index (RI) and Pulsatility Index (PI) following transfusion in infants of all 3 groups. The pre-transfusion mean Superior Vena Cava (SVC) flow decreased significantly in Group 1 (p=0.03) and Group 3 (p<0.001) following transfusion, but the change was not significant in the Group 2 infants (p=0.16). The mean pre-transfusion cerebral tissue oxygenation index (cTOI) levels were significantly lower in group 3 compared to group 1 (p=0.02). The cerebral tissue haemoglobin level cTHI (p<0.001) and cTOI (p<0.05) increased significantly post-transfusion in all the three groups. The percentage increase in post-transfusion cTOI from baseline was 5%, 11% and 12% in group 1, group 2 and group 3 3 | P a g e infants respectively. On comparing infants with PDA (n=14) to gestational and chronological age matched controls (n=14), there was no significant difference in these measurements.Baseline cTOI decrease and ACA TAMV increase with increasing chronological age. Blood transfusion increased cTOI and cTHI, and decreased ACA TAMV in all age group of infants but the proportion of response is different. PDA had no impact on the baseline cerebral oximetry and blood flow as well as changes following transfusion. Future transfusion trials should take into account the impact of postnatal age on cerebral oximetry and blood flow.

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“…In the neonatal population, there is an increasing awareness of the excess morbidity and mortality associated with PRBC transfusions (5,6). PRBC transfusions have been implicated in the development of problems not encountered in the adult population, including chronic lung disease (7), retinopathy of prematurity (8), and necrotizing enterocolitis (9,10), with the incidence and severity of these conditions correlating with the number and volume of PRBC transfusions received (7,8).…”

mentioning

confidence: 99%

Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant

et al. 2012

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Background: Transfusion of packed red blood cells (PRBcs) saves lives in the neonatal critical care setting and is one of the most common interventions in the preterm infant. The number and volume of PRBc transfusions are associated with several major neonatal morbidities, although a direct causal link between transfusion and major neonatal morbidity is still to be proven. Transfusion-related immunomodulation (TRIM) may underlie these adverse outcomes, yet it has received little attention in the high-risk preterm infant. Methods: One transfusion event was studied in infants ≤28 wk gestation between 2 and 6 wk postnatal age (n = 28). Plasma inflammatory cytokines and markers of endothelial activation were measured in the infants before and 2-4 h after transfusion, as well as in the donor pack. results: Median (range) age at transfusion was 18 (14-39) days with the pretransfusion hemoglobin level at 9.8 (7.4-10.2) g/dl. Interleukin (IL)-1β (P = 0.01), IL-8 (P = <0.001), tumor necrosis factor-α (P = 0.008), and monocyte chemoattractant protein (P = 0.01) were increased after transfusion. a similar elevation in markers of endothelial activation was seen after transfusion with increased plasma macrophage inhibitory factor (P = 0.005) and soluble intracellular adhesion molecule-1 (P = <0.001). conclusion: Production of inflammatory cytokines and immunoactivation of the endothelium observed after the transfusion of PRBcs in the preterm infant may be a manifestation of TRIM. The implications of this emerging phenomenon within the preterm neonatal population warrant further investigation. t ransfusion of blood products is not benign. In adults, transfusion is an independent predictor of death and is associated with an increased incidence of multiorgan system failure, length of hospital stay, infection risk, and modulation of the immune system (1,2). Although the mechanisms underlying these associations are yet to be comprehensively characterized, a two-hit model of posttransfusion injury has been proposed (3). In the clinical setting of an underlying inflammatory state priming the recipient's immune system, transfusion of packed red blood cells (PRBCs) may trigger immune cell activation and related immunomodulation, resulting in frank inflammation (4). This transfusion-related immunomodulation (TRIM), encompassing not only adverse proinflammatory and immunosuppressive responses but also the whole spectrum of posttransfusion effects on organs and tissues, has been proposed to underlie much of the increased transfusionassociated morbidity and mortality seen in adults (4).In the neonatal population, there is an increasing awareness of the excess morbidity and mortality associated with PRBC transfusions (5,6). PRBC transfusions have been implicated in the development of problems not encountered in the adult population, including chronic lung disease (7), retinopathy of prematurity (8), and necrotizing enterocolitis (9,10), with the incidence and severity of these conditions correlating with the number and volume of PRBC tran...

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Red Blood Cell Transfusions are Independently Associated with Intra-Hospital Mortality in Very Low Birth Weight Preterm Infants

Cited by 114 publications

References 28 publications

Allogeneic Umbilical Cord Blood Red Cell Concentrates: An Innovative Blood Product for Transfusion Therapy of Preterm Infants

Allogeneic Umbilical Cord Blood Red Cell Concentrates: An Innovative Blood Product for Transfusion Therapy of Preterm Infants

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Plasma cytokines and markers of endothelial activation increase after packed red blood cell transfusion in the preterm infant

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