Adverse outcomes after red blood cell transfusion in very low birth weight infants in a resource-restricted hospital.

BACKGROUND

Red blood cell transfusions (RBCTs) in preterm infants are associated with various adverse outcomes including transfusion-associated necrotizing enterocolitis (TANEC) and transfusion-related late-onset sepsis (TR-LOS). This study aimed to determine the adverse outcomes of RBCTs in very low birth weight infants (VLBWI) at a resource-restricted hospital in Cape Town, South Africa.

STUDY DESIGN AND METHODS

A retrospective descriptive analysis of all VLBWI who received a RBCT in 2020 was performed. Univariate and multivariate logistic regression were performed to determine the association of adverse events after single, multiple, early, and late RBCTs.

RESULTS

The study cohort included 178 VLBWI, representing a RBCT prevalence of 22.2%. The mean gestational age was 28 weeks and the mean birth weight was 0.99 kg. The first RBCT occurred at a mean of 27 days and at an Hb <8 g/dL, differing significantly between single, multiple early, and late RBCT groups. After adjusting for confounders, multiple RBCTs showed a strong association with TR-LOS within 3 days (aOR 9.22, 95th CI 2.30; 36.91, p = .002), TR-LOS within 7 days (aOR 8.39, 95th CI 2.72; 25.89, p < .001), any NEC ≥ Bell stage 2 (aOR 2.34, 95th CI 1.66; 11.78, p = .026), BPD (aOR 3.62, 95th CI 1.37; 9.54, p = .009) and mortality (aOR 3.58, 95th CI 1.39; 9.22, p = .008). After adjusting for confounders, early RBCTs were strongly associated with mortality (aOR 2.47, 95th CI 1.28; 8.90, p = .013).

DISCUSSION

Multiple RBCTs may be associated with TR-related sepsis. This requires more research in resource-restricted areas with a high burden of disease.