The objective of this study was to examine the changes in level of respiratory support following transfusion in neonates who require intermediate or intensive care.
Data on respiratory support were collected retrospectively from the medical record before, during and after transfusion. Neonatal post transfusion lung injury (NPTLI) was defined as an increase in the highest mean airway pressure (MAP) of =2?cm H(2)O or FiO(2) >0.15 in the 6-h after transfusion that persisted from 6 to 18?h post transfusion.
A total of 373 (330 packed red blood cell) transfusions were given to 108 infants. NPTLI occurred following 31 (8.3%) transfusions in 23 patients. During the first 6?h after transfusion, FiO2 or MAP was increased in 47 transfusions (12.6%) and the changes persisted in 31 transfusions (7.8%). Infants who developed NPTLI were less mature (27.1±0.7 vs 31.0±0.5?weeks; P=0.005) and of lower birth weight (1001±110 vs1692±104?g; P=0.001). Infants who developed NPTLI were more likely to develop necrotizing enterocolitis (6/24 vs 4/85; P=0.002) and die within 24?h of transfusion (5/22 vs 3/85; P=0.003).
In neonates receiving intensive or intermediate care, blood transfusion was associated with need for increased respiratory support in a significant number of cases. Development of NPTLI was associated with poorer outcomes.