Association Between Packed Red Blood Cell Transfusion and Acute Lung Injury in Very Low Birth Weight Infants: A Self- Matched Longitudinal Study

Objective: One serious morbidity of packed red blood cell (pRBC) transfusion in very low birth weight infants (VLBW) is acute lung injury (ALI). This study aimed to determine the association between pRBC transfusion and changes in the level of respiratory support within 6 hours after transfusion (post-transfusion respiratory decompensation, PTRD) in VLBW infants. Additionally, this study assessed the possible association of bronchopulmonary dysplasia (BPD) with transfusions within the first 7 days of life and identified risk factors for PTRD.Material and Methods: This historical, time-based, self-matched cohort study was conducted on VLBW infants that received their first pRBC transfusion. ALI during the exposure period (0-6 hours after transfusion, PTRD) was compared with ALI occurrences in the pre- and post-exposure periods. Associations were evaluated using mixed effects logistic regression. Results: Five hundred and ten VLBW infants receiving pRBC transfusion were enrolled in the study. Twenty-six percent (132/510) of infants developed PTRD, compared with 17% and 9% developing ALI in pre- and post-exposure periods, respectively. Mixed-effects logistic regression indicated an increased risk during the exposure period compared with non-exposure periods [odds ratio (OR) (95% confidence interval (CI): 1.59 (1.22, 2.36) p-value=0.002, and 3.90 (2.62, 5.82) p-value<0.001, respectively]. Early, first pRBC transfusion within the first 7 days of life was not associated with BPD [adjusted odds ratio (aOR) 0.90 (0.26, 1.32) p-value=0.600]. Conclusion: First, pRBC transfusions were associated with PTRD in VLBW infants. BPD was not associated with transfusion within 7 days of life. Further studies should prospectively focus on the causal relationships leading to PTRD.