Introduction: Neonatal postoperative outcomes may be negatively affected by perioperative red blood cell transfusion (RBCT). This study compared 30-day postoperative outcomes between transfused and non-transfused neonates.
Methods: The National Surgical Quality Improvement Program (NSQIP) Pediatric dataset (2021-2022) was used to analyze the association between RBCT and 30-day morbidity and mortality after neonatal surgery. RBCT was defined as transfusion during or within 72 h after surgery. Propensity score matching compared transfused and non-transfused neonates. Secondary analyses examined outcomes among matched neonates with relative anemia and mortality trends across deciles of preoperative hematocrit (Hct).
Results: Overall, 2687 neonates underwent surgery during the study period, and 14 % received PRBCT. In the matched cohort, 30-day mortality was higher in transfused neonates (26.2 % vs. 13.8 %, p < 0.0001). Transfused neonates also had increased rates of wound dehiscence (2.2 % vs. 0.9 %; p < 0.005), mechanical ventilation >48 h (60.3 % vs. 43.7 %; p < 0.0001), cardiac arrest (3.8 % vs. 2.3 %; p = 0.022), and septic shock (3.8 % vs. 1.1 %; p < 0.0001). Matched neonates with similar rates of PRBCT had comparable morbidity and mortality, regardless of preoperative Hct (<35 % vs. >40 %). Mortality diverged significantly above Hct 33 % for transfused neonates, increasing steadily with higher Hct.
Conclusions: Perioperative RBCT is associated with worse postoperative morbidity and mortality, particularly at higher preoperative Hct levels. Relative preoperative anemia alone is not a significant predictor of outcomes, supporting restrictive transfusion practices in perioperative neonatal care.
Type of study: Retrospective Comparative Study.
Level of evidence: III.
Keywords: Blood; NICU; Neonatal; Neonatal care; Neonatal surgery; Pediatric surgery; Transfusion.
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