Early red blood cell transfusion and the occurrence of intraventricular hemorrhage in very preterm infants

• Published in: Early human development Vol. 189; p. 105926
• Main Authors: Skubisz, Aleksandra, de Vries, Linda S., Jansen, Sophie J., van der Staaij, Hilde, Lopriore, Enrico, Steggerda, Sylke J.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2024
• Subjects: Advanced Basic Science; Infant; Intraventricular hemorrhage; Neonatal and Perinatal Medicine; Premature; Red blood cell transfusion; CUS; Premature; Red blood cell transfusion; RBC; PVHI; PHVD; pCO2; Infant; IVH; GA; Intraventricular hemorrhage; Red blood cell; Periventricular hemorrhagic infarction; Gestational age; Partial pressure of carbon dioxide; Cranial ultrasound; Posthemorrhagic ventricular dilatation
• ISSN: 0378-3782; 1872-6232; 1872-6232
• DOI: 10.1016/j.earlhumdev.2023.105926

Preterm infants are at risk of developing both intraventricular hemorrhage (IVH) and anemia of prematurity. Several studies reported an association between early postnatal red blood cell (RBC) transfusion and IVH, however the timing and causality between these two remains unclear. To describe the temporal sequence between administration of early RBC transfusion (within the first week of life) and diagnosis of IVH in very preterm infants. Retrospective single center case-series. 132 very preterm infants (<32 weeks' gestation), admitted to a level III neonatal intensive care unit, studied with serial cranial ultrasound (CUS), and diagnosed with any grade of IVH. Number and timing of early RBC transfusions in relation to the timing of IVH. Median time of IVH diagnosis was 20.5 h after birth (interquartile range [IQR], 6.25–49.00 h). Of those who received an early RBC transfusion (36 %, 47/132), only 15 % (20/132) received it before the IVH diagnosis. Infants with RBC transfusion before IVH more frequently had lower birth weight, received less fequently antenatal steroids, required more often invasive mechanical ventilation and surfactant administration, had more often hypo- and hypercapnia, and received more fluid boluses, NaHCO3, and inotropes compared to the rest. In the majority of infants, IVH was already present at the time of the first RBC transfusion. Studies including pre- and post RBC transfusion CUS are needed to assess the effect of early RBC transfusions on the development of IVH in preterm neonates. •An association between RBC transfusion and preterm IVH was reported previously.•With serial CUS we show that IVH was often already present before the transfusion.•Infants with transfusion before IVH diagnosis often had additional risk factors.•Therefore, the causal relation between RBC transfusion and IVH remains unclear.