Pediatric anesthesia & critical care
Perioperative Blood Transfusion, Postoperative Hemoglobin, and Clinical Outcomes in Neonates: A Retrospective Observational Study From a Large Quaternary Hospital
Authors' conclusion
We report >22% of neonates were exposed to a RBC transfusion perioperatively in our entire surgical cohort with an incidence of >50% of those transfused being over transfused to Hb levels ≥12.0 g/dL. Our results suggest that transfusion volumes >25 mL/kg may be associated with worse outcomes.
Study context
- Population
- Neonates undergoing noncardiac surgery at Boston Children's Hospital, January 2017 to December 2023274 transfused
- Participants
- 1,305 neonates
- Outcome
- Rate of perioperative RBC transfusion in the total neonatal surgical cohort and incidence of over transfusion (immediate postoperative Hb ≥12.0 g/dL) in transfused neonates
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Perioperative red blood cell (RBC) transfusion rate (297/1305)
22.8%
Over transfusion among transfused neonates (140/274)
51.1%
Postoperative hemoglobin (Hb) in over-transfused neonates, median (range 12.0-21.3)
13.9
Observational data: associations, not effects.
Further findings
Risk factors for over transfusion: preoperative Hb
| OR (95% CI) | P value | ||
|---|---|---|---|
| Preoperative Hb 10–13 g/dL | 0.28 (0.14–0.53) | P < 0.001 | |
| Preoperative Hb <10 g/dL | 0.18 (0.07–0.44) | P < 0.001 | |
| 0.050.21520Odds ratio (log scale) |
Total transfusion volume by 30-day mortality
P < 0.001
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| 30-day mortality per extra 5 mL/kg RBCs transfused | 1.05 (1.01–1.09) | P = 0.027 | |
| 0.512Odds ratio (log scale) |
- 30-day mortality per extra 5 mL/kg RBCs transfused: adjusted for age, weight, prematurity, preoperative anemia, emergency procedure, ASA-PS
Over transfusion and postoperative outcomes
- No significant association with hospital LOS
- P = 0.151
- No significant association with neonatal intensive care unit (NICU) stay
- P = 0.549
- No significant association with composite morbidity
- P = 0.868
- No significant association with 24-hour mortality
- P = 0.051
- No significant association with 30-day mortality
- P = 0.094
- No significant association with 1-year mortality
- P = 0.672
Transfusion volume >25 mL/kg threshold and mortality
- Significantly associated with increased 30-day mortality (median 41.0 [IQR 20.2-115.2] vs 20.7 [IQR 14.8-34.0])
- P < 0.001
- Significantly associated with increased 1-year mortality (median 26.3 [IQR 19.6-62.5] vs 20 [IQR 14.7-33.3])
- P < 0.004
30-day mortality (30/274)
- 30-day mortality
- 10.9%
Original publication
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