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Packed red blood cell transfusions as a risk factor for parenteral nutrition associated liver disease in premature
Antoni D'Souza1, Anushree Algotar1, Ling Pan1
1Antoni D'Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children's Hospital at Downstate, Brooklyn, NY 11203, United States.
Insights
Premature infants receiving higher volumes of packed red blood cell (PRBC) transfusions had a significantly increased risk of developing parenteral nutrition associated liver disease (PNALD). This pilot study highlights a potential link between transfusion volume and liver complications in neonates.
Area of Science:
- Neonatology
- Hepatology
- Pediatric Gastroenterology
Background:
- Parenteral nutrition (PN) is essential for premature infants but is associated with liver disease.
- The role of packed red blood cell (PRBC) transfusions in PN-associated liver disease (PNALD) development is not well understood.
Purpose of the Study:
- To investigate the association between PRBC transfusions and PNALD in premature infants.
- To determine if the volume of PRBC transfusions correlates with PNALD incidence.
Main Methods:
- Retrospective chart review of 49 premature infants on PN for over 30 days.
- PNALD defined by direct bilirubin > 2.0 mg/dL; high transfusion cohort received > 75 mL PRBCs.
- Kaplan-Meier plots used to estimate transfusion volume thresholds for PNALD development.
Main Results:
- PNALD occurred in 43% of infants.
- Infants receiving > 75 mL PRBCs had a significantly higher incidence of PNALD (64%).
- All infants transfused with > 200 mL PRBCs developed PNALD; similar trends observed with elevated liver enzymes.
Conclusions:
- A statistically significant correlation exists between the volume of PRBC transfusions and PNALD development in premature infants.
- This pilot study suggests PRBC transfusion volume is a risk factor for PNALD.
- Further research is warranted to confirm these findings and explore underlying mechanisms.
Aim:
To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease.
Methods:
A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell (PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin (db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells (the median value). Kaplan-Meier plots estimated the median volume of packed red blood cells received in order to develop parenteral nutrition associated liver disease.
Results:
Parenteral nutritional associated liver disease (PNALD) was noted in 21 (43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17 (64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.
Conclusion:
In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.
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