Higher PRBC transfusion volume and frequency are associated with higher risk of moderate-to-severe bronchopulmonary dysplasia or mortality in extremely preterm infants: A retrospective cohort study

Several studies have reported inconsistent findings regarding the impact of packed red blood cell (PRBC) transfusions in extremely preterm infants (EPIs). Using a retrospective cohort study design, we investigated the relationship between different volumes and frequencies of PRBC transfusions and the morbidity and mortality in this vulnerable population. During the 3-year research period, our study encompassed 146 infants, ultimately enrolling 101 after a comprehensive screening process. Based on the medium volume of PRBC transfusions, 50 EPIs were classified into a higher-volume PRBC transfusion group (higher PRBC volume transfusion [HVT], > 45.5ml) and 51 infants were in the lower volume PRBC transfusion group (lower PRBC volume transfusion [LVT], < 45.5ml). Complications included intraventricular hemorrhage, hemodynamically significant patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia (BPD), and mortality were compared between groups. Statistical analysis was carried out using IBM SPSS Statistics. In the HVT group, 5 infants did not develop BPD while 45 did; among these, 28 (56%) developed mild BPD, 11 moderate, and 6 severe. Critically, no patients in the LVT group developed severe BPD. The study showed HVT infants had differences in characteristics and outcomes compared to those with LVT. There were no significant differences in the rates of intraventricular hemorrhage, hemodynamically significant patent ductus arteriosus, necrotizing enterocolitis, and retinopathy of prematurity (more than II level) between the 2 groups. After adjustment for potential confounding risk factors, higher PRBC transfusion volume was associated with elevated odds of moderate-to-severe BPD or mortality (adjusted odds ratio 2.839, 95% confidence interval [CI]: 1.006–8.014, P = .049). A significant positive correlation was identified between higher volumes of PRBC transfusions ( R = 0.371, P < .001) and the frequency of transfusions ( R = 0.320, P = .001) with moderate-to-severe BPD or mortality. Additionally, both volume and frequency of transfusion demonstrated moderate predictive accuracy for moderate-to-severe BPD or mortality in EPIs, with cutoff 45.5 ml and 4 times, with areas under the curve of 0.69 (95% CI: 0.58–0.79, P < .05) and 0.7 (95% CI: 0.59–0.80, P < .05), respectively. Our findings indicate that both volume and frequency of transfusions were associated with an increased risk of moderate-to-severe BPD or mortality in EPIs. Clinicians should exercise increased caution regarding PRBC transfusions, even when adhering to restrictive transfusion criteria.