Red Blood Cell Transfusion and Clinical Outcomes in Very Low Birth Weight Neonates: A Prospective Observational Study

Background The association between blood transfusions and the development of adverse outcomes in neonates remains unclear. Method We conducted a cross-sectional study in 200 very low birth weight (VLBW) preterm infants who received any red blood cell (RBC) transfusion from December 15, 2022, to August 31, 2023, in a level 3 center in a low- to middle-income setting. We aimed to study the associations between RBC transfusion and in-hospital mortality and short-term morbidities in VLBW preterm infants. A logistic regression model was used to estimate the association between mortality outcome and a set of covariates. Results The mean gestational age (GA) and birth weight (BW) were 30.79 ± 2.27 weeks and 1139.32 ± 200.74 g, respectively. The average initial hemoglobin level was 15.73 ± 2.42 g/dL, and the hematocrit was 51.88 ± 10.28%. Of 200 neonates, 137 (68.5%) received a single RBC, and 63 (31.5%) received multiple RBC transfusions. Univariate analysis showed that GA, BW, and delayed cord clamping were significantly lower in VLBW infants who received RBC transfusion and died as compared to survivors. It also showed a significantly increased need for resuscitation in the delivery room, apnea, pulmonary hemorrhage, and intraventricular hemorrhage during hospital stay before death in comparison to survivors. We also found that these factors accounted for approximately 27.7% of the variance in mortality. Conclusion We found the subset of a sicker cohort of VLBW infants to have higher transfusion needs, and are at a greater risk of neonatal complications; however, without an increased risk of mortality.