Predictive factors and practice trends in red blood cell transfusions for very-low-birth-weight infants

Background: Red blood cell (RBC) transfusions in very-low-birth-weight (VLBW) infants, while common, carry risk. Our objective was to determine clinical predictors of and trends in RBC transfusions among VLBW infants. Methods: RBC transfusion practice and its clinical predictors in 1,750 VLBW (≤1,500 g) infants were analyzed in a single-center cohort across sequential epochs: 2000–2004 (Epoch 1), 2005–2009 (Epoch 2), and 2010–2013 (Epoch 3). Results: Overall, 1,168 (67%) infants received ≥1 transfusions. The adjusted likelihood of ≥1 transfusions decreased for each 1-g/dl increment in initial hemoglobin concentration following birth, for females, and for each 100-g increment in birth weight. The adjusted likelihood of ≥1 transfusions increased with infants receiving mechanical ventilation, with increasing length of hospital stay, necrotizing enterocolitis, and nonlethal congenital anomalies requiring surgery. The adjusted mean (SEM) number of transfusions per patient was decreased in Epoch 3, compared with Epoch 1 and Epoch 2. For an initial hemoglobin of ≥16.5 g/dl, the predicted probability of being transfused was ≤50%. Conclusion: Adjusted RBC transfusions declined and female sex conferred an unexplained protection over the study period. Modest increases in initial hemoglobin by placentofetal transfusion at delivery may reduce the need for RBC transfusion.