Investigation of the association between preterm infants’ red blood cell transfusion risk and maternal-neonatal characteristics Público

Abstract

Objectives: Red blood cell (RBC) transfusions are a crucial intervention for preterm infants, with the need for transfusions varying based on maternal and neonatal factors. Understanding these factors can enhance clinical decision-making and optimize transfusion practices.

 

Method: This study investigates the association between preterm infants’ RBC transfusion needs and key maternal and neonatal characteristics using three modeling approaches: (1) Quasi-Poisson regression to estimate transfusion rates, (2) the Anderson-Gill model to assess transfusion intensity over time, and (3) the Frailty model to account for individual heterogeneity in relative transfusion risk.

 

Results: This study highlights the significant influence of maternal and neonatal characteristics on the RBC transfusion needs of preterm infants. Among the three models applied, the multivariable Frailty model provided the most robust risk estimates by accounting for individual heterogeneity. The NICU center where an infant was born played a crucial role in transfusion outcomes. While a higher proportion of infants born at Grady received at least one transfusion compared to those at Emory and Northside, the Frailty model revealed that the adjusted relative risk of transfusion was lower at Grady (RR = 0.88, 95% CI: 0.58, 1.34[kE1] ). After adjusting for center, maternal race, and maternal age, each additional week of gestational age reduced the relative risk of transfusion by 15% (RR = 0.85; 95% CI: 0.78, 0.92, P < .001). Similarly, every 100g increase in birth weight was associated with a 23% reduction in transfusion risk (RR = 0.77; 95% CI: 0.71, 0.83, P < .001). Additionally, the adjusted RR of transfusion per 1g/dL decrease in hemoglobin at birth was 1.11; 95% CI: 1.04, 1.17, P <.001).

 

Conclusion: The estimated risk of transfusions for all covariates are similar across three models while the Frailty model indicating a moderate within-subject correlation between transfusion times. Despite relatively homogenous preterm infant population, gestational age, birth weight, and hemoglobin levels at birth remained significant predictors of transfusion risk. Furthermore, we found the transfusion risks are significantly different across centers. 

Table of Contents

1.      Introduction 1

2.      Method 4

1.1          Study Population 4

1.2          Statistical Analysis 5

1.2.1      Quasi Poisson Model 6

1.2.2      Anderson Gill Model 7

1.2.3      Frailty Model 8

3.      Results 10

3.1          Description of Exposures and Outcomes 10

3.2          Risk Factors for RBC Transfusion Needs 15

3.2.1      Quasi Poisson Model 15

3.2.2      Anderson Gill Model 16

3.2.3      Frailty Model 17

3.3          Risk Factors for Low Birth Weight 22

4.      Discussion 24

5.      References 29

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Women's Studies
Palavra-chave	Preterm Infant Repeated RBC Transfusions
Committee Chair / Thesis Advisor	Amita Manatunga, Emory University
Committee Members	Kirk Easley, Emory University

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