Characteristics of red blood cell transfusion among very preterm infants in China

Abstract Background and Objectives National‐level data on the incidence of red blood cell (RBC) transfusions and outcomes among very preterm infants (VPIs) are lacking in China. This study aims to describe the use and variation of RBC transfusion among VPIs in China. Materials and Methods This cohort study was conducted among 70 tertiary hospitals participating in the Chinese Neonatal Network (CHNN) from 2019 to 2020 across China. All VPIs admitted to the CHNN neonatal intensive care units (NICUs) were included. Results A total of 13,447 VPIs were enrolled, of whom 7026 (52.2%) received ≥1 RBC transfusions. The mean number of transfusions per infant was 2 (interquartile range [IQR] 1–4 times) and the median age at first transfusion was 15 days (IQR 3–27 days). The transfusion rate was higher in critically ill infants compared with non‐critically ill infants (70.5% vs. 39.3%). The transfusion rate varied widely (13.5%–95.0%) between different NICUs. The prevalence of death, severe intra‐ventricular haemorrhage, necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP), sepsis, bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (ROP) and cystic periventricular leukomalacia (cPVL) was significantly higher in the transfused group. Among non‐critically ill infants, RBC transfusion was independently associated with BPD, severe ROP and cPVL. Conclusion Our study, providing the first baseline data on RBC transfusions among VPIs in China, shows an alarmingly high RBC transfusion rate with significant site variations. There is an urgent need for national guidelines on RBC transfusions for VPIs in China.