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Published on: August 19, 2020
Association Between Transfusion of RBCs and Subsequent Development of Delirium in Critically Ill Children
Marianne E Nellis1, Ruchika Goel2, Sydney Feinstein1
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY.
Insights
Red blood cell (RBC) transfusions are independently associated with delirium in critically ill children. Even small amounts of transfused RBCs increased the risk of delirium or coma within 72 hours.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Transfusion medicine
Background:
- Delirium is a common complication in critically ill children.
- The role of red blood cell (RBC) transfusions in the development of delirium is not well understood.
Purpose of the Study:
- To investigate the association between RBC transfusions and delirium in critically ill children.
- To determine if there is a temporal relationship between RBC transfusion and delirium onset.
Main Methods:
- A nested retrospective cohort study was conducted within a prospective cohort.
- 1,547 critically ill children admitted to a pediatric intensive care unit (PICU) were screened for delirium.
- Data on RBC transfusions and delirium development were collected and analyzed.
Main Results:
- Children receiving RBC transfusions were more than twice as likely to develop delirium (adjusted odds ratio, 2.16).
- A temporal relationship was observed: for every 10 mL/kg of RBCs transfused, the risk of delirium or coma within 72 hours increased by 90% (adjusted odds ratio, 1.90).
- Anemia was not associated with delirium development.
Conclusions:
- RBC transfusions are independently associated with an increased risk of delirium in critically ill children.
- Further research is needed to explore the underlying mechanisms of this association.
Objectives:
To determine the temporal relationship between the transfusion of RBCs and the subsequent development of delirium in a cohort of critically ill children.
Design:
Nested retrospective cohort study within prospective cohort study.
Setting:
Urban academic tertiary care PICU.
Patients:
All consecutive admissions from September 2014 through August 2015.
Interventions:
Children were screened twice daily for delirium during their PICU admission.
Measurements And Main Results:
Among 1,547 independent admissions screened for delirium, 166 (10.7%) were transfused RBCs. Children who were transfused RBCs were more than twice as likely to be delirious during their admission compared with children who were never transfused, after controlling for known predictors of delirium development (adjusted odds ratio, 2.16; 95% CI, 1.38-3.37; p = 0.001). Among transfused children, a temporal relationship was observed between receipt of RBCs and the subsequent development of delirium. For each additional 10 mL/kg of RBCs transfused, the recipients were 90% more likely to develop delirium or coma in the 72 hours following the transfusion, after controlling for confounders (adjusted odds ratio, 1.90; 95% CI, 1.14-3.17; p = 0.01). Anemia (represented by nadir hemoglobin prior to transfusion) was not associated with delirium development.
Conclusions:
In this cohort of critically ill children, there is an independent association between the receipt of an RBC transfusion and the subsequent development of delirium. Further prospective studies are warranted to replicate this finding and investigate possible pathophysiologic mechanisms for this association.
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