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- Title
Clinical Outcomes Following Institution of Universal Leukoreduction of Blood Transfusions for Premature Infants.
- Authors
Fergusson, Dean; Hébert, Paul C.; Lee, Shoo K.; Walker, C. Robin; Barrington, Keith J.; Joseph, Lawrence; Blajchman, Morris A.; Shapiro, Stan
- Abstract
Context: Leukocytes present in stored blood products can have a variety of biological effects, including depression of immune function, thereby increasing nosocomial infections and possibly resulting in organ failure and death. Premature infants, given their immature immune state, may be uniquely predisposed to the effects of transfused leukocytes. Objective: To evaluate the clinical outcomes following implementation of a universal prestorage red blood cell (RBC) leukoreduction program in premature infants admitted to neonatal intensive care units (NICUs). Design and Setting: Retrospective before-and-after study conducted in 3 Canadian tertiary care NICUs from January 1998 to December 2000. Patients: A total of 515 premature infants weighing less than 1250 g who were admitted to the NICU, received at least 1 RBC transfusion, and survived at least 48 hours were enrolled. The intervention group consisted of infants admitted in the 18-month period following the introduction of universal leukoreduction (n = 247) and the control group consisted of infants admitted during the 18 months prior to the introduction of universal leukoreduction (n = 268). Main Outcome Measures: Primary outcomes were nosocomial bacteremia and NICU mortality, compared before and after implementation of universal leukoreduction using multivariate regression. Secondary outcomes included bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and intraventricular hemorrhage. Results: The proportion of infants who acquired bacteremia after an RBC transfusion was 79/267 (29.6%) in the nonleukoreduction period and 63/246 (25.6%) in the leukoreduction period. For NICU mortality, there were 45 deaths (16.8%) in the nonleukoreduction period and 44 deaths (17.8%) in the leukoreduction period. The adjusted odds ratio (OR) for bacteremia was 0.59 (95% confidence interval [CI], 0.34-1.01) and for mortality was 1.22 (95% CI, 0.59-2.50). The adjusted ORs for bronchopulmonary...
- Subjects
PREMATURE infants; LEUCOCYTES; BLOOD cells; BACTEREMIA; NEONATAL intensive care; NEONATAL diseases; MORTALITY; MEDICAL research
- Publication
JAMA: Journal of the American Medical Association, 2003, Vol 289, Issue 15, p1950
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.289.15.1950