Introduction: Red blood cell transfusion (RBCT) is commonly administered in neonatal surgical care in the absence of clear clinical indications such as active bleeding or anemia.
We hypothesized that higher RBCT volumes are associated with worse postoperative outcomes.
Methods: Neonates within the National Surgical Quality Improvement Program–Pediatric database who underwent inpatient surgery (2012–2016) were stratified by weight-based
RBCT volume: < 20cc/kg, 20–40cc/kg, and > 40cc/kg. Postoperative complications were categorized as wound, systemic infection, cen- tral nervous system (CNS), renal,
pulmonary, and cardiovascular. Multivariable logistic regression and cu- bic spline analysis were used to evaluate the association between RBCT volume, postoperative complications, and 30-day mortality. Sensitivity analysis was conducted by performing propensity score matching.
Results: Among 9,877 neonates, 1,024 (10%) received RBCTs. Of those who received RBCT, 53% received < 20cc/kg, 27% received 20–40cc/kg, and 20% received > 40cc/kg.
Relative to neonates who were not trans- fused, RBCT volume was associated with a dose-dependent increase in renal complications, CNS compli- cations, cardiovascular
complications, and 30-day mortality. With cubic spline analysis, a lone inflection point for 30-day mortality was identified at a RBCT volume of 30 –35 cc/kg. After propensity score
matching, the dose-dependent relationship was still present for 30-day mortality.
Conclusion: Total RBCT volume is associated with worse postoperative outcomes in neonates with a significant increase in 30-day mortality at a RBCT volume of 30 –35 cc/kg.
Future prospective studies are needed to better understand the association between large RBCT volumes and poor outcomes after neonatal surgery.