Enteral iron supplementation, red blood cell transfusion, and risk of bronchopulmonary dysplasia in very-low-birth-weight infants

• Type of Material: Article
• Authors: Ravi Patel, Emory University; Andrea Knezevic, Emory University; Jing Yang, Emory University; Neeta Shenvi, Emory University; Michael Hinkes, Northside Hospital; John Roback, Emory University; Kirk Easley, Emory University; Cassandra Josephson, Emory University
• Language: English
• Date: 2019-05-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 AABB.
• Final Published Version (URL): http://dx.doi.org/10.1111/trf.15216
• Title of Journal or Parent Work: Transfusion
• Volume: 59
• Issue: 5
• Start Page: 1675
• End Page: 1682
• Grant/Funding Information: This study was supported by the National Institutes of Health (NIH). R.M.P. received salary support from the NIH National Center for Advancing Translational Sciences (NCATS) under awards UL1 TR000454 and KL2 TR000455 and from the National Heart Lung Blood Institute (NHLBI) under award K23 HL128942.; The parent study was funded by the NHLBI under award P01 HL086773. The NIH had no role in: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication.
• Keywords: Definition; Life Sciences & Biomedicine; Science & Technology; Oxygen; Hematology; Oxidative stress; Anemia; Chronic lung disease
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

BACKGROUND: Enteral iron supplementation and RBC transfusions are routinely administered to very-low-birth-weight (VLBW) infants, although the potential risks of these exposures have not been adequately quantified. This study evaluated the association between the cumulative dose of enteral iron supplementation, total volume of RBCs transfused, and risk of bronchopulmonary dysplasia (BPD) in VLBW infants. STUDY DESIGN AND METHODS: Retrospective, multicenter observational cohort study in Atlanta, Georgia. Cumulative supplemental enteral iron exposure and total volume of RBCs transfused were measured until the age at assessment of BPD. Multivariable generalized linear models were used to control for confounding, and the reliability of the factors was assessed in 1000 bootstrap models. RESULTS: A total of 598 VLBW infants were studied. In multivariable analyses, a greater cumulative dose of supplemental enteral iron exposure was associated with an increased risk of BPD (adjusted relative risk per 50-mg increase, 1.07; 95% confidence interval [CI], 1.02–1.11; p = 0.002). Similarly, a greater volume of RBCs transfused was associated with a higher risk of BPD (adjusted relative risk per 20-mL increase, 1.05; 95% CI, 1.02–1.07; p < 0.001). Both factors were reliably associated with BPD (>50%). Volume of RBCs transfused was similar to gestational age in reliability as a risk factor for BPD (present in 100% of models) and was more reliable than mechanical ventilation at 1 week of age. CONCLUSION: The cumulative dose of supplemental enteral iron exposure and total volume of RBC transfusion are both independently associated with an increased risk of BPD in VLBW infants.