Anemia in low and very low birth weight premature infants: Determinants of red blood cells transfusion

Background: Red blood cell (RBC) transfusion is a widely used intervention in neonatal care, particularly for preterm infants, to correct anemia and reduce the risk of mortality. Preterm infants, especially those with very low birth weight, often require transfusions due to immature hematopoietic systems, frequent blood sampling, and other clinical challenges. Aim of the Study: This study aims to identify the key risk factors associated with red blood cell transfusion among very low birth weight preterm infants. Patients and Methods: A retrospective cross-sectional study was conducted over a six-month period from October 1, 2024, to March 31, 2025, in the Neonatal Intensive Care Units of Baghdad Teaching Hospital and Children Welfare Teaching Hospital, Baghdad, Iraq. A total of 100 premature infants were included. The need for RBC transfusion was determined by senior pediatricians based on clinical indicators such as hemoglobin and hematocrit levels, need for ventilation and supplemental oxygen, episodes of apnea and bradycardia, and inadequate weight gain. Results: There was a statistically significant association between maternal co-morbidities and the need for RBC transfusion (p=0.006). Infants with extremely low birth weight were more likely to require transfusion (p=0.01). A significantly lower Apgar score at 5 minutes was noted among infants who received transfusions (p=0.01). Mortality was also significantly associated with RBC transfusion (p=0.01). Conclusions: RBC transfusion in premature infants is linked with adverse outcomes. Major risk factors include maternal co-morbidity, extremely low birth weight, and low hematological indices.