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Blood Transfusion and Retinopathy of Prematurity – A Systematic Review And Meta-Analysis

Presented at the Neonatal Society 2014 Spring Meeting.

Asamoah F2,3, Banerjee J1,3, Aladangady N1,3,4, Morris JK2

1 Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
2 Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
3 Department of Neonatology, Homerton University Hospital NHS Foundation Trust, London, UK
4 Department of Paediatrics, SDM College of Medical Sciences & Hospital, Dharwad, India

Background: Retinopathy of Prematurity (ROP) is an important cause of visual impairment and blindness globally in children (1). Premature infants frequently receive blood transfusions (2), which have been reported as a risk factor for ROP (3). Objective: To determine the association between blood transfusion and the development of ROP in preterm infants ≤ 32 weeks gestational age or <1500 grams birthweight.

Methods: Data Sources: MEDLINE, EMBASE, Cochrane Register of Controlled Trials, CINAHL, LILACS, Web of Knowledge, clinicaltrial.gov and Open SIGLE were searched for relevant studies. Study Selection Criteria: Cohort and case-control studies published from year 2000 that assessed the effect of blood transfusion on ROP development for infants born at <1500 grams or ≤32 weeks of gestational age. From 816 articles screened, 363 were selected for further assessment. Nine studies met the final selection criteria. Four reviewers independently assessed the study eligibility. Data Extraction and Analysis: The outcome measure was ‘all stages of ROP’ based on the International classification of ROP. A random effects meta-analysis model was used to obtain the pooled odds ratio and the heterogeneity of the studies was assessed using the I2 statistic.

Results: The median gestational age was 30 weeks and birth weight 1228 grams in the 2,106 preterm infants in the nine studies. Blood transfusion was associated with the development of ROP; unadjusted odds ratio (OR) = 3.05 (95% CI 2.16 to 4.32). However there was significant heterogeneity between these studies I2 = 54.8% p=0.02. Three of these studies also reported adjusted ORs; the unadjusted pooled OR = 2.59 (95% CI 1.35 to 4.98) and the pooled OR adjusted for birth weight, gestational age and other factors= 1.18 (95% CI 0.96 to 1.33), I2 = 8.8%.

Conclusion: Blood transfusion was associated with the development of ROP in preterm infants. However once other factors such as gestational age and birth weight were adjusted for, the association between blood transfusion and ROP development was considerably weaker. This study highlights the need for more studies to adjust for potential confounding factors.

Corresponding author: f.k.asamoah@qmul.ac.uk

1. Gilbert C. Changing challenges in the control of blindness in children. Eye (Lond) 2007; 21: 1338 – 43
2. Maier RF. Et al. Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g. J Pediatr 2000;13
6:220-4. 3. Dani C. et al. The role of blood transfusions and iron intake on retinopathy of prematurity. Early Human Development 62 (2001) 57–63

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