Many newborns get a blood transfusion because of surgery, but could preoperative blood transfusion do more harm than good?
Using blood transfusions in newborns is not uncommon, even though there are no guidelines providing guidance for transfusion thresholds. Additionally, there is little information on the postoperative outcomes of newborns who are given preoperative blood transfusions. A report in Pediatrics offers some much needed information.1
The researchers used the American College of Surgeons National Surgical Quality Improvement Program–Pediatric Participant Use Data Files from 2012 to 2015. They found all of the newborns who underwent a surgical procedure during the period. Both mortality and composite morbidity, which was labelled as any postoperative complication, were examined for newborns who received a preoperative blood transfusion within 48 hours of surgery and then compared to newborns who did not get a transfusion.
There were 12,184 newborns identified in the data and 1209 of those newborns were given a preoperative blood transfusion. Researchers found that the newborns who had received a transfusion had worse postoperative outcomes as well as higher rates of preoperative comorbidities (composite morbidity: 46.2% vs 16.2%; P < .01). Following multivariable regression analysis, they found that postoperative blood transfusions were independently linked with an increased 30-day morbidity (odds ratio [OR] = 1.90; 95% CI: 1.63–2.22; P < .01) and mortality (OR = 1.98; 95% CI: 1.55–2.55; P < .01). Similarly, in propensity score–matched analysis the transfusions continued their association with increased 30-day morbidity (OR = 1.53; 95% CI: 1.29–1.81; P < .01) and mortality (OR = 1.58; 95% CI: 1.24–2.01; P = .01).
The investigators concluded that preoperative blood transfusions were independently linked with both increased mortality and morbidity among newborns who underwent surgery. They believe that further prospective data are required to better illustrate how red blood cell transfusions impact patients in the neonatal population.
1. Dukleska K, Vinocur C, Brenn B, et al. Preoperative blood transfusions and morbidity in neonates undergoing surgery. Pediatrics. October 21, 2020. Epub ahead of print. doi:10.1542/peds.2019-3718