Risk factors of red blood cell infusion in very low/ultra-low birth weight neonates with respiratory distress syndrome

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Risk factors of red blood cell infusion in very low/ultra-low birth weight neonates with respiratory distress syndrome

Journal Title: Chinese Journal of Blood Transfusion - Year 2023, Vol 36, Issue 8

Abstract

Objective To investigate the risk factors of red blood cell transfusion frequency (fRBCT) toward newborns with very/extremely low birth weight (V/ELBW) who experienced <32 weeks of gestational age and were complicated with neonatal respiratory distress syndrome (NRDS), and to explore related complications and predictive indicators that can arise from increased fRBCT, so as to provide safe and scientific blood transfusion recommendations for children with NRDS. Methods A total of 585 cases of V/ELBW NRDS newborns who experienced <32 weeks of gestational age between January 2016 and December 2020 were retrospectively collected. They were divided into three groups according to the fRBCT throughout their hospitalization[fRBCT = 0(n = 97), 1 ≤fRBCT≤2(n = 253), and fRBCT≥3(n= 235) ]. Clinical data and laboratory parameters of all three groups were compared to identify the risk factors of increased blood transfusion frequency toward V/ELBW NRDS newborns. Results Statistically significant differences in gestational age (week) (30.72±1.84 vs 29.87±1.66 vs 28.29±1.46), birth weight(g) (1 366.19± 128.12 vs 1 265.20± 163.98 vs 1 081.73± 196.06), hemoglobin level(g/L) (172.37±19.98 vs 161.96±21.41 vs 154.33±24.61) and hematocrit ratio(%) (50.46±5.74 vs 47.69±5.55 vs 45.46±6.84) at admission, as well as duration of hospital stay(d) (40 vs 51 vs 68), non-invasive ventilation(d) (6 vs 11.01 vs 24.56) and intravenous nutrition (IVN) (d) (16.73 vs 22.37 vs 30.74) were found among all three groups (all P<0.05) . Duration of invasive ventilation in Group fRBCT ≥3 (7.66 days) were significantly higher than those in Group fRBCT = 0 and Group 1 ≤fRBCT≤2, showing statistically significant differences (P<0.05). Pairwise comparison of the incidences of hematosepsis (1%, 1/97 vs 4%, 10/253 vs 9.4%, 22/235 ), retinopathy of prematurity (ROP) (16.5%, 16/97 vs 17%, 43/253 vs 46.8%, 110/235) and bronchopulmonary dysplasia (BPD) (4.1%, 4/97 vs 19%, 48/253 vs 59.1%, 139/235) among the three groups demonstrated statistically significant differences (P<0.05). The incidence of neonatal necrotizing enterocolitis (NEC) in Group fRBCT≥3 (26.8%, 63/235) also showed statistically significant differences in relation to Group fRBCT = 0 (P<0.05). Multivariate logistic regression analysis also proved that duration of hospital stay, invasive ventilation and IVN were independent risk factors for Group fRBCT≥ 3 (OR= 1.048, 1.073, and 1.030; all P<0.05). The receiver operating characteristic (ROC) curves indicated that duration of hospital stay, invasive ventilation and IVN made better predictors for Group fRBCT≥3. Areas under the ROC curves were 0.841, 0.766 and 0.716, while the corresponding cutoff values were respectively >57 days, >2.75 days and >23.75 days. Conclusion Increased fRBCT may complicate V/ELBW NRDS newborns who experienced <32 weeks of gestational age with NEC, hematosepsis, BPD and ROP. Duration of hospital stay, invasive ventilation and IVN are relatively effective predictive indicators for whether such cases have undergone ≥3 red blood cell transfusions throughout their hospitalization.

Authors and Affiliations

Jiawen CHEN, Yiling XIE, Yong YANG

Keywords

EP ID EP738613
DOI 10.13303/j.cjbt.issn.1004-549x.2023.08.010
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