Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: May 8, 2024
Date Accepted: Jun 18, 2024
Red Blood Cell Transfusion for Incidence of Retinopathy of Prematurity: Prospective Multicenter Cohort Study
ABSTRACT
Background:
Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants.
Objective:
This study sought to investigate the association between red blood cell (RBC) transfusion and ROP in very preterm infants (VPIs) to inform clinical strategies for ROP prevention and treatment.
Methods:
We designed a multi-center retrospective cohort study that included very preterm infants and follow-up data from January 2017 to December 2022 at three neonatal clinical medicine centers. They were categorized into a transfusion group (infants who received an RBC transfusion within 4 weeks) and a non-transfusion group. The relationship between RBC transfusion and ROP incidence was assessed using binary logistic regression, with subgroup analyses based on gestational age, sex, and birth weight. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were applied to account for all potential confounding factors that could affect ROP development, followed by sensitivity analysis.
Results:
The study included 832 VPIs, including 327 in the non-transfusion group and 505 in the transfusion group. The transfusion group had a lower average birth weight and gestational age and a greater incidence of ROP, ≥stage 2 ROP, and severe ROP. Logistic regression analysis revealed that the transfusion group had a significantly greater risk of ROP (aOR=1.70, 95% CI 1.14-2.53, P=0.009) and ≥stage 2 ROP (aOR=1.68, 95% CI 1.02-2.78, P=0.043) but not severe ROP (aOR=1.75, 95% CI 0.61-5.02, P=0.300). Trend analysis also revealed an increased risk of ROP with an increasing number of transfusions and a larger volume of blood transfused (P for trend <0.001). Subgroup analyses confirmed a consistent trend, with the transfusion group at a higher risk for ROP across all subgroups. IPTW and PSM analyses supported the initial findings.
Conclusions:
For VPIs, RBC transfusion significantly increases the risk of ROP, and the risk increases with an increasing number of transfusions and volume of blood transfused.
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