VARIATIONS IN BLOOD-TRANSFUSIONS AMONG NEWBORN INTENSIVE-CARE UNITS

Objectives: Very low birth weight (<1500 g) infants frequently require packed red blood cell transfusions, and transfusion rates vary among neonatal intensive care units (NICUs). We analyzed transfusions and co mpared outcomes among NICUs. Study design: In a 6-site prospective stu dy, we abstracted all newborns weighing <1500 g (total = 825) born bet ween October 1994 and September 1995. Transfusion frequency and volume and phlebotomy number were analyzed by site and adjusted for birth we ight and illness severity. We compared rates of intraventricular hemor rhage, necrotizing enterocolitis, bronchopulmonary dysplasia, growth, and length of stay between the high and low transfuser NICUs. Results: Sites differed significantly in mean birth weight, illness severity, number of transfusions, pretransfusion hematocrit, blood draws, and do nor number. Multivariate adjustment for these risks showed that the hi ghest transfusing NICU transfused an additional 24 cc/kg per baby duri ng the first 14 days and 47 cc/kg per baby after 15 days, relative to the lowest transfusing NICU. The presence of arterial catheters increa sed the frequency of blood transfusions. The rates of intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia were not higher in the 2 lowest transfusing NICUs, nor were there dif ferences in 28-day weight gain or length of stay. Conclusions: Major d ifferences in transfusion practices for very low birth weight infants exist among NICUs. Because clinical outcomes were no different in lowe r transfuser NICUs, it is likely that transfusion and phlebotomy guide lines could result in fewer transfusions, fewer complications, and red uced cost.