Does Red Blood Cell Transfusion-Related Acute Lung Injury Occur in Premature Infants? A Retrospective Cohort Analysis.

 The objective of this study was to determine whether packed red blood cell (pRBC) transfusions in extremely low birth weight (ELBW) infants were associated with acute respiratory decompensation (ARD).  Retrospective chart review of ELBW infant pRBC transfusions analyzed for meeting ARD criteria during the 6 hours post-pRBC transfusion was compared with the pretransfusion baseline period. A control period subdivided into similar pre- and postintervals was also assessed for each infant. ARD was defined as ≥ 1 of the following: (1) ≥ 10% increase in fraction of inspired oxygen from highest baseline, (2) ≥ 2 cm HO increase from highest baseline in mean airway pressure, or (3) escalation in mode of respiratory support.  A total of 238 pRBC transfusions occurred in 36 ELBW infants during 2012. Complete data for both the transfusion and control time periods existed for 110 pRBC transfusions (25 infants) and were included for analysis. The frequency of ARD was 15.5 and 18.2% (odds ratio, 1.25;  = 0.70) in the control and transfusion time periods, respectively.  pRBC transfusions in ELBW neonates are not associated with statistically significant rates of ARD compared with nontransfusion control time periods.