Association of red blood cell transfusions with periventricular leukomalacia in very preterm infants

Red blood cell (RBC) transfusions have been associated with retinopathy of prematurity (ROP) and adverse long-term neurodevelopmental outcomes in very preterm infants. Although lower transfusion thresholds reduce the incidence of ROP, they have not improved neurological outcome. Periventricular leukomalacia (PVL) is a major cause of long-term neurodevelopmental impairment in very preterm infants. The objective of this study was to determine whether exposure to RBC transfusions is an independent, dose-dependent risk factor for PVL.

A retrospective cohort study was conducted. Infants born at 32 weeks of gestation or less or with a birth weight <1500 g were eligible. Infants transferred from other hospitals, managed with palliative care or who died before cranial imaging were excluded. Exposure was defined as the cumulative number of RBC transfusions during neonatal intensive care. Outcomes were PVL and severe ROP. Multivariable logistic regression analyses were performed and stratified by birth weight <750 g and ≥750 g.

RBC transfusions were independently associated with PVL and ROP. The adjusted odds ratio was 1.10 and 1.09, respectively, in infants weighing <750 g, and 1.26 and 1.15 in infants weighing 750 g or more, respectively, with statistically significant confidence intervals.

RBC transfusions were independently associated with PVL in preterm infants. As lowering transfusion thresholds has not been associated with improved neurological outcomes, consideration of cord blood products may be warranted.