Related Experiment Videos
Changing patterns of red blood cell transfusion in very low birth weight infants
J A Widness1, V J Seward, I J Kromer
1Department of Pediatrics, University of Iowa, Iowa City 52242, USA.
Insights
Red blood cell transfusions for very low birth weight (VLBW) infants have significantly decreased due to improved neonatal care and awareness of transfusion risks. Focus remains on the sickest VLBW infants weighing 1 kg or less during their first weeks of life.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Critical Care Pediatrics
Background:
- Anemia is common in critically ill very low birth weight (VLBW) infants surviving the neonatal period.
- These infants often require multiple red blood cell (RBC) transfusions.
- Improved neonatal care and awareness of transfusion risks may reduce RBC transfusion rates.
Purpose of the Study:
- To investigate trends in RBC transfusion practices for VLBW infants.
- To determine if RBC transfusion rates have decreased over time.
- To identify factors influencing transfusion patterns in VLBW infants.
Main Methods:
- Retrospective analysis of RBC transfusion practices and clinical outcomes.
- Study included infants with birth weights of 1.5 kg or less.
- Data analyzed from three distinct years: 1982, 1989, and 1993.
Main Results:
- Significant declines in RBC transfusions, donor exposures, and transfusion volumes were observed.
- Transfusions per infant decreased from 7.0 in 1982 to 2.3 in 1993 (p < 0.001).
- The percentage of VLBW infants receiving no transfusions increased, but infants weighing 1 kg or less consistently received transfusions.
Conclusions:
- Neonatal RBC transfusion administration has decreased markedly.
- Therapeutic strategies should target VLBW infants weighing 1 kg or less during the critical first weeks of life.
- Temporal changes highlight the importance of concurrent controls in transfusion intervention studies.
Objective:
Anemia develops in increasing numbers of critically ill very low birth weight (VLBW) infants who survive the neonatal period, and they receive multiple red blood cell (RBC) transfusions. Despite their need for prolonged medical treatment, we hypothesized that VLBW infants presently receive fewer RBC transfusions as a result of the growing awareness of transfusion risks and improvement of neonatal care.
Methods:
RBC transfusion practices and clinical outcomes in infants with birth weights of 1.5 kg or less were analyzed retrospectively in three selected years: 1982, before awareness of the human immunodeficiency virus; 1989, before surfactant availability; and 1993, before erythropoietin approval.
Results:
Progressive declines in RBC transfusions, donor exposures, and transfusion volumes occurred concurrently with decreases in morbidity and mortality rates. Transfusions per infant (mean +/- SD) declined from 7.0 +/- 7.4 in 1982 to 5.0 +/- 5.8 in 1989 to 2.3 +/- 2.7 in 1993 (p < 0.001). This decline was associated with a decrease in pretransfusion hematocrit (33.6% +/- 2.8% in 1982, 34.2% +/- 3.7% in 1989, and 29.8% +/- 5.1% in 1993; p < 0.001). The distribution of RBC transfusions given by week of life among study years did not change; 70% of RBC transfusions were given within the first 4 weeks, when infants are sickest. Although the percentage of VLBW infants weighing more than 1 kg at birth and never receiving any RBC transfusions increased with time (17% in 1982, 33% in 1989, and 64% in 1993), more than 95% of infants weighing 1 kg or less in all years received transfusions.
Conclusions:
Overall administration of neonatal transfusions has decreased markedly, most likely because of multiple factors. Because most RBC transfusions are given to infants weighing 1 kg or less in the first weeks of life, therapeutic strategies should focus on this group of VLBW infants during this critical period. The temporal changes observed in transfusion patterns emphasize the importance of including concurrent controls in future studies evaluating transfusion interventions.