Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Nov 8, 2016; 5(4): 365-369
Published online Nov 8, 2016. doi: 10.5409/wjcp.v5.i4.365
Packed red blood cell transfusions as a risk factor for parenteral nutrition associated liver disease in premature infants
Antoni D’Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz
Antoni D’Souza, Anushree Algotar, Ling Pan, Steven M Schwarz, William R Treem, Gloria Valencia, Simon S Rabinowitz, Department of Pediatrics, Children’s Hospital at Downstate, Brooklyn, NY 11203, United States
Author contributions: D’Souza A and Valencia G provided the neonatal clinical care in the nursery assisted in the collection of the data and critically reviewed the manuscript after completion; Algotar A created some of the figures, participated in writing of the final manuscript and critically reviewed the manuscript after completion; Pan L collated all of the data collection and organization, created some of the figures, and participated in writing an earlier draft of the manuscript; Schwarz SM assisted in the analysis of the data, performed the statistical analysis, supervised the creation of the figures and critically reviewed the manuscript after completion; Treem WR designed the study, supervised the collection of the data and participated in the analysis of the data, and had input into the final draft of the manuscript, he also critically reviewed and edited the manuscript after completion; Rabinowitz SS reanalyzed the data and wrote the final draft of the manuscript, he oversaw the entire completion of the project.
Institutional review board statement: This study was approved by the Institutional Review Board of SUNY Downstate Medical Center.
Informed consent statement: As this was a retrospective chart review, informed consent was waived by the institutional review board.
Conflict-of-interest statement: None of the authors involved in this study have any conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Simon S Rabinowitz, MD, PhD, FAAP, Professor, Department of Pediatrics, Children’s Hospital at Downstate, SUNY Downstate, 445 Lenox Road Box 49, Brooklyn, NY 11203, United States. simon.rabinowitz@downstate.edu
Telephone: +1-718-2701647 Fax: +1-718-2701985
Received: May 31, 2016
Peer-review started: June 3, 2016
First decision: July 25, 2016
Revised: September 20, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: November 8, 2016
Processing time: 159 Days and 19.2 Hours
Abstract
AIM

To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease.

METHODS

A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell (PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin (db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells (the median value). Kaplan-Meier plots estimated the median volume of packed red blood cells received in order to develop parenteral nutrition associated liver disease.

RESULTS

Parenteral nutritional associated liver disease (PNALD) was noted in 21 (43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17 (64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.

CONCLUSION

In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.

Keywords: Packed red blood cell transfusion; Neonatal intensive care unit; Parenteral nutrition associated liver disease

Core tip: The etiology of parenteral nutrition associated liver disease (PNALD), a commonly encountered morbidity in the neonatal intensive care unit (NICU) remains unknown. Potentially hepatotoxic packed red blood cell (PRBC) transfusions are routinely administered in this setting. Whether PRBC transfusions increase the prevalence of PNALD is a clinical question that has not been systematically investigated. This pilot study demonstrated that in a cohort of NICU infants who received greater volumes of PRBC, there was a significantly higher prevalence of PNALD. Further investigations to define the exact risk are warranted to minimize NICU stays, costs, and future liver damage.