Clinical Outcomes Following Institution of Universal Leukoreduction of Blood Transfusions for Premature Infants

摘要: ContextLeukocytes present in stored blood products can have a variety of biological effects, including depression immune function, thereby increasing nosocomial infections and possibly resulting organ failure death. Premature infants, given their immature state, may be uniquely predisposed to the effects of transfused leukocytes.ObjectiveTo evaluate clinical outcomes following implementation universal prestorage red cell (RBC) leukoreduction program premature infants admitted neonatal intensive care units (NICUs).Design SettingRetrospective before-and-after study conducted 3 Canadian tertiary care NICUs from January 1998 December 2000.PatientsA total 515 infants weighing less than 1250 g who were admitted NICU, received at least 1 RBC transfusion, survived at least 48 hours were enrolled. The intervention group consisted 18-month period introduction universal leukoreduction (n = 247) control admitted during 18 months prior (n 268).Main Outcome MeasuresPrimary nosocomial bacteremia NICU mortality, compared before after using multivariate regression. Secondary included bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage.ResultsThe proportion acquired an transfusion was 79/267 (29.6%) nonleukoreduction 63/246 (25.6%) the leukoreduction period. For there 45 deaths (16.8%) in the 44 (17.8%) period. The adjusted odds ratio (OR) for was 0.59 (95% confidence interval [CI], 0.34-1.01) mortality 1.22 CI, 0.59-2.50). adjusted ORs dysplasia retinopathy prematurity 0.42 (95% 0.25-0.70) 0.56 0.33-0.93), respectively. enterocolitis grade or 4 hemorrhage were 0.39 0.17-0.90) 0.65 0.35-1.19), respectively. The OR composite measure any major morbidity was 0.31 0.17-0.56). Crude rates all secondary outcomes suggest that associated with improved outcomes.ConclusionImplementation prestorage not associated with significant reductions but improvement several requiring RBC transfusions.