The impact of leukoreduced red blood cell transfusion on mortality of neonates undergoing extracorporeal membrane oxygenation.
BACKGROUND: Blood products containing leukocytes have been associated with negative immunomodulatory and infectious effects. Transfusion-related acute lung injury is partially explained by leucocyte agglutination. The Food and Drug Administration has therefore recommended leukoreduction strategies for blood product transfusion. Our institution has been using leukocyte-reduced blood via filtration for neonates on Extracorporeal Membrane Oxygenation (ECMO). We hypothesized that the use of leukocyte-reduced blood would decrease mortality and morbidity of neonatal ECMO patients.
METHODS: Retrospective review of noncardiac ECMO in neonates from 1984-2011, stratified into year groups I and II (≤1996 and ≥1997). Demographics, duration and type of ECMO, complications, and outcome data were collected. Blood product use data was collected. Univariate, bivariate, and multivariate analyses determined predictors of risk-adjusted mortality by year group.
RESULTS: Patients (827) underwent ECMO with 65.3% (540) in group I. Overall median blood product use in mL/kg/d was 36.2 packed red blood cells (pRBC), 8.1 platelets, and 0 cyroprecipitate and/or fresh-frozen plasma. Overall mortality was 16.4%. Median pRBC used or transfused was 42.1 mL/kg/d in group I versus 19.1 mL/kg/d group II (P
CONCLUSIONS: Blood transfusion requirement has diminished in newborns undergoing ECMO at our institution. Transfusion of non leukocyte-reduced blood is associated with an increase in mortality whereas transfusion of leukocyte-reduced blood provided no benefit with a trend toward increased mortality. Further research is recommended to understand these trends.
The Journal of surgical research
Erythrocyte Transfusion; Extracorporeal Membrane Oxygenation; Familial Primary Pulmonary Hypertension; Female; Hernias; Diaphragmatic; Congenital; Hospital Mortality; Humans; Infant; Newborn; Intensive Care; Neonatal; Leukocyte Reduction Procedures; Male; Meconium Aspiration Syndrome; Morbidity; Retrospective Studies
ECMO; Blood Transfusion; Red Blood Cells; Newborns; Mortality
Jackson, Hope T.; Oyetunji, Tolulope A.; Thomas, Alexandra; Oyetunji, Aderonke O.; Hamrick, Miller; Nadler, Evan P.; Wong, Edward; and Qureshi, Faisal G., "The impact of leukoreduced red blood cell transfusion on mortality of neonates undergoing extracorporeal membrane oxygenation." (2014). Manuscripts, Articles, Book Chapters and Other Papers. 39.