Association Between Packed Red Blood Cell Transfusion and Acute Lung Injury in Very Low Birth Weight Infants: A Self-Matched Longitudinal Study
Abstract
Objective: One serious morbidity of packed red blood cell (pRBC) transfusion in very low birth weight infants (VLBW) is acute lung injury (ALI). This study aimed to determine the association between pRBC transfusion and changes in the level of respiratory support within 6 hours after transfusion (post-transfusion respiratory decompensation, PTRD) in VLBW infants. Additionally, this study assessed the possible association of bronchopulmonary dysplasia (BPD) with transfusions within the first 7 days of life and identified risk factors for PTRD.
Material and Methods: This historical, time-based, self-matched cohort study was conducted on VLBW infants that received their first pRBC transfusion. ALI during the exposure period (0-6 hours after transfusion, PTRD) was compared with ALI occurrences in the pre- and post-exposure periods. Associations were evaluated using mixed effects logistic regression.
Results: Five hundred and ten VLBW infants receiving pRBC transfusion were enrolled in the study. Twenty-six percent (132/510) of infants developed PTRD, compared with 17% and 9% developing ALI in pre- and post-exposure periods, respectively. Mixed-effects logistic regression indicated an increased risk during the exposure period compared with non-exposure periods [odds ratio (OR) (95% confidence interval (CI): 1.59 (1.22, 2.36) p-value=0.002, and 3.90 (2.62, 5.82) p-value<0.001, respectively]. Early, first pRBC transfusion within the first 7 days of life was not associated with BPD [adjusted odds ratio (aOR) 0.90 (0.26, 1.32) p-value=0.600].
Conclusion: First, pRBC transfusions were associated with PTRD in VLBW infants. BPD was not associated with transfusion within 7 days of life. Further studies should prospectively focus on the causal relationships leading to PTRD.
Keywords
Full Text:
PDFReferences
Ghirardello S, Dusi E, Cortinovis I, Villa S, Fumagalli M, Agosti M. Effects of red blood cell transfusions on the risk of developing complications or death: an observational study of a cohort of very low birth weight infants. Am J Perinatol 2017;34:88-95.
Collard K. Transfusion related morbidity in premature babies: Possible mechanisms and implications for practice. World J Clin Pediatr 2014;3:19-29.
Rashid N, Al-Sufayan F, Seshia M, Baier R. Post transfusion lung injury in the neonatal population. J Perinatol 2013;33:292- 96.
Cokyaman T, Kavuncuoglu S. Bronchopulmonary dysplasia frequency and risk factors in very low birth weight infants: a 3-year retrospective study. North Clin Istanb 2020;7:124-30.
Valieva O, Strandjord T, Mayock D, Juul S. Effects of transfusions in extremely low birth weight infants: a retrospective study. J Pediatr 2009;155:331-37.
Gupta S, Som T, Iyer L, Agarwal R. Transfusion related acute lung injury in a neonate. Indian J Pediatr 2012;79:1363-5.
Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med 2005;33:721-6.
Grev JE, Stanclova M, Ellsworth MA, Colby CE. Does red blood cell transfusion-related acute lung injury occur in premature infants? A retrospective cohort analysis. Am J Perinatol 2017; 34:14-8.
Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion 1985;25:573-7.
Silliman CC, Boshkov LK, Mehdizadehkashi Z, Elzi DJ, Dickey WO, Podlosky L, et al. Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood 2003;101:454-62.
Chakraborty M, McGreal EP, Kotecha S. Acute lung injury in preterm newborn infants: mechanisms and management. Paediatr Respir Rev 2010;11:162-70.
Looney M, Roubinian N, Gajic O, Gropper M, Hubmayr R, Lowell C. Prospective study on the clinical course and outcomes in transfusion-related acute lung injury. Crit Care Med 2014;42:1676-87.
Vlaar A, Binnekade J, Prins D, Van Stein D, Hofstra J, Schultz M. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med 2010;38:771-8.
Yildirim I, Ipek MS, Zorlu P, Yarali N. Transfusion-related acute lung injury (TRALI): a report of two pediatric cases. Pediatr Hematol Oncol 2008;25:319-24.
Maria A, Agarwal S, Sharma A. Acute respiratory distress syndrome in a neonate due to possible transfusion-related acute lung injury. Asian J Transfus Sci 2017;11:203-5.
Higgins RD, Jobe AH, Koso-Thomas M, Bancalari E, Viscardi RM, Hartert TV, et al. Bronchopulmonary dysplasia: executive summary of a workshop. J Pediatr 2018;197:300-8.
Christensen RD. Neonatal erythrocyte disorders. In: Gleason CA, Juul SE, editos. Avery’s diseases of the newborn. Philadelphia: Elsevier; 2018:1152-79.
Arlettaz R. Echocardiographic evaluation of patent ductus arteriosus in preterm infants. Front Pediatr 2017;5:147.
Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986;33:179- 201.
Gephart SM. Transfusion-associated necrotizing enterocolitis: evidence and uncertainty. Adv Neonatal Care 2012;12:232-6.
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-34.
Whyte RK, Jefferies AL, Canadian Paediatric Society F, Newborn C. Red blood cell transfusion in newborn infants. Paediatr Child Health 2014;19:213-22.
Dupont W. Power and sample size calculations. Controlled Clinical Trials 1990;11:116-28.
Marik PE, Corwin HL. Acute lung injury following blood transfusion: expanding the definition. Crit Care Med 2008;36:3080-4.
Iliodromiti Z, Zygouris D, Sifakis S, Pappa KI, Tsikouras P, Salakos N, et al. Acute lung injury in preterm fetuses and neonates: mechanisms and molecular pathways. J Matern Fetal Neonatal Med 2013;26:1696-704.
Kramer BW, Kallapur S, Newnham J, Jobe AH. Prenatal inflammation and lung development. Semin Fetal Neonatal Med 2009;14:2-7.
Janjindamai W, Prapruettrong A, Thatrimontrichai A, Dissaneevate S, Maneenil G, Geater A. Risk of necrotizing enterocolitis following packed red blood cell transfusion in very low birth weight infants. Indian J Pediatr 2019;86:347-53.
Sinitsky L, Walls D, Nadel S, Inwald DP. Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study. Pediatr Crit Care Med 2015;16:205-9.
Ingelse SA, Wösten-van Asperen RM, Lemson J, Daams JG, Bem RA, van Woensel JB. Pediatric acute respiratory distress syndrome: fluid management in the PICU. Front Pediatr 2016; 4:21.
Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants. Sci Rep 2014;4:4340. doi: 10.1038/srep04340.
Duan J, Kong X, Li Q, Hua S, Zhang S, Zhang X, et al. Association between anemia and bronchopulmonary dysplasia in preterm infants. Sci Rep 2016;6:22717. doi: 10.1038/srep22717.
Ming S, Zhang D, Chen L, Shi Y. Effects of anemia and red blood cell transfusion in preterm infants on the development of bronchopulmonary dysplasia: a propensity score analysis. All Life 2021;14:830-9.
Hayes D Jr, Feola DJ, Murphy BS, Shook LA, Ballard HO. Pathogenesis of bronchopulmonary dysplasia. Respiration 2010; 79:425-36.
Niedermaier S, Hilgendorff A. Bronchopulmonary dysplasia - an overview about pathophysiologic concepts. Mol Cell Pediatr 2015;2:2.
Poindexter BB, Jobe AH. The diagnostic conundrum of bronchopulmonary dysplasia. J Pediatr 2015;167:517-8.
Keszler M, Sant’Anna G. Mechanical ventilation and bronchopulmonary dysplasia. Clin Perinatol 2015;42:781-96.
Schena F, Francescato G, Cappelleri A, Picciolli I, Mayer A, Mosca F, et al. Association between hemodynamically significant patent ductus arteriosus and bronchopulmonary dysplasia. J Pediatr 2015;166:1488-92.
Collard KJ, Godeck S, Holley JE. Blood transfusion and pulmonary lipid peroxidation in ventilated premature babies. Pediatr Pulmonol 2005;39:257-61.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.