Transfusion of blood products and neonatal outcomes in preterm infants: A retrospective cohort study

This retrospective study investigated blood product transfusions and neonatal morbidity and mortality in preterm infants with birth weights <1500 g and gestational ages <32 weeks.

We conducted a retrospective cohort study of 291 preterm infants admitted to our neonatal intensive care unit between January 2020 and December 2022. Data were collected on transfusion exposure, including packed red blood cells (RBC), fresh frozen plasma (FFP), and platelets. Clinical outcomes included mortality and major neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Univariate analyses were performed, followed by multivariable logistic regression to adjust for confounding factors including birth weight and gestational age.

80% of infants received RBC transfusion, 37.8% received FFP, and 16.1% received platelets. Transfused infants had lower gestational ages and birth weights. RBC, FFP, and platelet transfusions were associated with higher rates of BPD, IVH, NEC, and mortality in univariate analyses. In multivariable analysis, birth weight alone predicted mortality, suggesting extreme prematurity and illness severity were primary drivers. RBC transfusion independently predicted NEC and BPD, while FFP and platelet transfusions were linked to BPD. Total transfusions correlated with higher BPD, NEC, and mortality rates. Early transfusions were linked to impaired survival.

These findings suggest transfusions may not be independently associated with mortality, but may instead reflect underlying illness severity. However, they remain associated with serious morbidities in extremely preterm infants. The results emphasize the importance of judicious transfusion practices, evidence-based thresholds, and research to clarify potential causal relationships.