Packed Red Blood Cell Transfusion as a Predictor of Moderate-Severe Bronchopulmonary Dysplasia: A Comparative Cohort Study of Very Preterm Infants.

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is a leading cause of morbidity and mortality in neonatal intensive care units. Our aim was to evaluate association between packed red blood cell transfusion and the development of BPD in very preterm infants.

STUDY DESIGN: This retrospective study of very preterm infants (mean gestational age 27.1 ± 2.4 weeks, birthweight 970 ± 271 g) was conducted at Biruni University (Turkey) between July 2016 and December 2020.

RESULTS: BPD developed in 107 of the 246 enrolled neonates, including 47 (43.9%), 27 (25.3%), and 33 (30.8%) diagnosed with mild, moderate, and severe BPD, respectively. A total of 728 transfusions were administered. The increased number (4 transfusions [2-7] vs. 1 [1-3], p = 0.001) and volume of transfusions (75 mL/kg volume [40-130] vs. 20 [15-43], p = 0.001) were significantly higher in infants with BPD compared to those without BPD. The transfusion volume cut-off for the prediction of BPD by ROC curve analysis was 42 mL/kg (sensitivity 73.6%; specificity 75%; area under the receiver-operating characteristic curve 0.82). In multivariate analysis, multiple transfusions and larger transfusion volume were independent risk factors for moderate-severe BPD.

CONCLUSION: The increased number and volume of transfusions were associated with BPD in very preterm infants. A packed red blood cell transfusion volume ≥ 42 mL/kg was a statistically significant predictor of the development of BPD at a postmenstrual age of 36 weeks.