Impact of Perioperative Blood Transfusion on Postoperative Outcomes in Neonates

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.