Association of Red Blood Cell Transfusion Volume with Postoperative Complications and Mortality in Neonatal Surgery
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Read the article on jpedsurg.org ↗Article · Jan 2022 · 1 min read
In brief
In brief
This retrospective study of nearly 10,000 neonatal surgical patients found that red blood cell transfusion volume shows a dose-dependent association with increased postoperative complications and mortality, with a critical threshold identified at 30-35 cc/kg. The findings suggest clinicians should carefully weigh transfusion decisions in neonatal surgery given the correlation between higher volumes and adverse outcomes including renal, CNS, and cardiovascular complications.
Written by the GCMD Library team from the article.
Introduction: Red blood cell transfusion (RBCT) is commonly administered in neonatal surgical care in the absence of clear clinical indications such as active bleeding or anemia. We hypothesized that higher RBCT volumes are associated with worse postoperative outcomes.
Methods: Neonates within the National Surgical Quality Improvement Program–Pediatric database who underwent inpatient surgery (2012-2016) were stratified by weight-based RBCT volume: 40cc/kg. Postoperative complications were categorized as wound, systemic infection, central nervous system (CNS), renal, pulmonary, and cardiovascular. Multivariable logistic regression and cubic spline analysis were used to evaluate the association between RBCT volume, postoperative complications, and 30-day mortality. Sensitivity analysis was conducted by performing propensity score matching.
Results: Among 9,877 neonates, 1,024 (10%) received RBCTs. Of those who received RBCT, 53% received 40cc/kg. Relative to neonates who were not transfused, RBCT volume was associated with a dose-dependent increase in renal complications, CNS complications, cardiovascular complications, and 30-day mortality. With cubic spline analysis, a lone inflection point for 30-day mortality was identified at a RBCT volume of 30 – 35 cc/kg. After propensity score matching, the dose-dependent relationship was still present for 30-day mortality.
Conclusion: Total RBCT volume is associated with worse postoperative outcomes in neonates with a significant increase in 30-day mortality at a RBCT volume of 30 – 35 cc/kg. Future prospective studies are needed to better understand the association between large RBCT volumes and poor outcomes after neonatal surgery.