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Red Blood Cell Transfusion for Incidence of Retinopathy of Prematurity: Prospective Multicenter Cohort Study
Xiaoling Wang1,2, Rui Rao2, Hua Li2
1Jinan University, Guangzhou, China.
Insights
Red blood cell (RBC) transfusions increase the risk of retinopathy of prematurity (ROP) in very preterm infants (VPIs). This risk escalates with more frequent transfusions and larger blood volumes, highlighting a need for careful transfusion strategies.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Hematology
Background:
- Retinopathy of prematurity (ROP) is a primary cause of vision loss in premature infants.
- Very preterm infants (VPIs) are particularly susceptible to ROP, necessitating effective prevention strategies.
Purpose of the Study:
- To investigate the association between red blood cell (RBC) transfusion and ROP incidence in VPIs.
- To provide evidence for optimizing clinical transfusion practices to prevent ROP.
Main Methods:
- Prospective multicenter cohort study of VPIs from January 2017 to December 2022.
- Comparison of ROP incidence between infants receiving RBC transfusions and those not, using logistic regression.
- Advanced statistical methods including inverse probability of treatment weighting and propensity score matching to control for confounding factors.
Main Results:
- The study included 832 VPIs; 505 received RBC transfusions and 327 did not.
- RBC transfusion was significantly associated with a higher risk of ROP (aOR 1.70) and stage ≥2 ROP (aOR 1.68).
- A dose-response relationship was observed, with increased transfusion frequency and volume correlating with higher ROP risk (P for trend<.001).
Conclusions:
- RBC transfusion is a significant risk factor for developing ROP in VPIs.
- The risk of ROP increases proportionally with the number and volume of RBC transfusions administered.
- Findings underscore the importance of judicious RBC transfusion management in VPIs to mitigate ROP risk.
Background:
Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants.
Objective:
This study sought to investigate the association between red blood cell (RBC) transfusion and ROP in very preterm infants (VPIs) to inform clinical strategies for ROP prevention and treatment.
Methods:
We designed a prospective multicenter cohort study that included VPIs and follow-up data from January 2017 to December 2022 at 3 neonatal clinical medicine centers. They were categorized into a transfusion group (infants who received an RBC transfusion within 4 wk) and a nontransfusion group. The relationship between RBC transfusion and ROP incidence was assessed using binary logistic regression, with subgroup analyses based on gestational age, birth weight, sex, and sepsis status. Inverse probability of treatment weighting and propensity score matching were applied to account for all potential confounding factors that could affect ROP development, followed by sensitivity analysis.
Results:
The study included 832 VPIs, including 327 in the nontransfusion group and 505 in the transfusion group. The transfusion group had a lower average birth weight and gestational age and a greater incidence of ROP, ≥stage 2 ROP, and severe ROP. Logistic regression analysis revealed that the transfusion group had a significantly greater risk of ROP (adjusted odds ratio [aOR] 1.70, 95% CI 1.14-2.53, P=.009) and ≥stage 2 ROP (aOR 1.68, 95% CI 1.02-2.78, P=.04) but not severe ROP (aOR 1.75, 95% CI 0.61-5.02, P=.30). The trend analysis also revealed an increased risk of ROP with an increasing number of transfusions and a larger volume of blood transfused (P for trend<.001). Subgroup analyses confirmed a consistent trend, with the transfusion group at a higher risk for ROP across all subgroups. Inverse probability of treatment weighting and propensity score matching analyses supported the initial findings.
Conclusions:
For VPIs, RBC transfusion significantly increases the risk of ROP, and the risk increases with an increasing number of transfusions and volume of blood transfused.
