Madhou Ashish, Lloyd Lizel G, Mundey Nadia, Nell Erica-Mari, van Wyk Lizelle
Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Western Cape Blood Services, Cape Town, South Africa.
Transfusion. 2025 May;65(5):897-908. doi: 10.1111/trf.18244. Epub 2025 Apr 7.
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.
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.
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).
Multiple RBCTs may be associated with TR-related sepsis. This requires more research in resource-restricted areas with a high burden of disease.
早产儿红细胞输血（RBCT）与多种不良结局相关，包括输血相关坏死性小肠结肠炎（TANEC）和输血相关迟发性败血症（TR-LOS）。本研究旨在确定南非开普敦一家资源有限的医院中极低出生体重儿（VLBWI）接受RBCT后的不良结局。
对2020年接受RBCT的所有VLBWI进行回顾性描述性分析。进行单因素和多因素逻辑回归以确定单次、多次、早期和晚期RBCT后不良事件的关联。
研究队列包括178例VLBWI，RBCT患病率为22.2%。平均胎龄为28周，平均出生体重为0.99kg。首次RBCT平均发生在27天，血红蛋白<8g/dL时，单次、多次早期和晚期RBCT组之间存在显著差异。在调整混杂因素后，多次RBCT与3天内的TR-LOS（调整后比值比[aOR]9.22，95%置信区间[CI]2.30；36.91，p = 0.002）、7天内的TR-LOS（aOR 8.39，95%CI 2.72；25.89，p < 0.001）、任何≥贝尔2期的坏死性小肠结肠炎（NEC）（aOR 2.34，95%CI 1.66；11.78，p = 0.026）、支气管肺发育不良（BPD）（aOR 3.62，95%CI 1.37；9.54，p = 0.009）和死亡率（aOR 3.58，95%CI 1.39；9.22，p = 0.008）密切相关。在调整混杂因素后，早期RBCT与死亡率密切相关（aOR 2.47，95%CI 1.28；8.90，p = 0.013）。
多次RBCT可能与TR相关败血症有关。这需要在疾病负担高的资源有限地区进行更多研究。
