Preoperative Blood Transfusions and Morbidity in Neonates Undergoing Surgery

Pediatrics. 2020 Nov;146(5):e20193718. doi: 10.1542/peds.2019-3718.


Background: Blood transfusions in the neonatal patient population are common, but there are no established guidelines regarding transfusion thresholds. Little is known about postoperative outcomes in neonates who receive preoperative blood transfusions (PBTs).

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Data Files from 2012 to 2015, we identified all neonates who underwent surgery. Mortality and composite morbidity (defined as any postoperative complication) in neonates who received a PBT within 48 hours of surgery were compared with that in neonates who did not receive a transfusion.

Results: A total of 12 184 neonates were identified, of whom 1209 (9.9%) received a PBT. Neonates who received a PBT had higher rates of preoperative comorbidities and worse postoperative outcomes when compared with those who did not receive a transfusion (composite morbidity: 46.2% vs 16.2%; P < .01). On multivariable regression analysis, PBTs were independently associated with increased 30-day morbidity (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 1.63-2.22; P < .01) and mortality (OR = 1.98; 95% CI: 1.55-2.55; P < .01). In a propensity score-matched analysis, PBTs continued to be associated with increased 30-day morbidity (OR = 1.53; 95% CI: 1.29-1.81; P < .01) and mortality (OR = 1.58; 95% CI: 1.24-2.01; P = .01).

Conclusions: In a propensity score-matched model, PBTs are independently associated with increased morbidity and mortality in neonates who undergo surgery. Prospective data are needed to better understand the potential effects of a red blood cell transfusion in this patient population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Transfusion / mortality*
  • Blood Transfusion / statistics & numerical data
  • Comorbidity
  • Confidence Intervals
  • Databases, Factual
  • Erythrocyte Transfusion / adverse effects
  • Erythrocyte Transfusion / mortality
  • Erythrocyte Transfusion / statistics & numerical data
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature / blood
  • Male
  • Odds Ratio
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality
  • Preoperative Care*
  • Propensity Score
  • Quality Improvement
  • Regression Analysis
  • Surgical Procedures, Operative / mortality*
  • Treatment Outcome