Exploring the influence of blood donor sex on outcomes in Australian very low birth weight infants.

Background and objectives: Despite many known benefits of red blood cell (RBC) transfusions for very low birth weight (VLBW) infants, there is increasing concern that they may be associated with adverse clinical outcomes and that donor characteristics (including donor sex) could contribute to these adverse outcomes.

Materials and methods: Outcomes of a 7-year (2016-2022) retrospective cohort of VLBW preterm infants born at Mater Mothers' Hospital who received at least one RBC transfusion and no other blood products were assessed. While adjusting for the number of transfusions administered to each neonate, we investigated the association between donor sex (expressed as the proportion of transfused RBC units collected from female donors) and standardized morbidity outcomes that are reported to the Australian and New Zealand Neonatal Network. These outcomes include bronchopulmonary dysplasia, late onset infection, retinopathy of prematurity and mortality.

Results: Analysis including 394 neonates who received a total of 820 RBC transfusions did not identify any statistically significant associations between blood donor sex and the outcomes of interest.

Conclusion: Our findings support the continued practice of administration of RBC transfusions to Australian VLBW neonates without consideration of blood donor sex. Further large, prospective, multi-centre studies are recommended to enhance the level of evidence addressing this clinical concern.