Intraoperative transfusion practice and associated outcomes following neonatal surgery in a middle-income country: A 5-year single center retrospective review

Abstract

Background: Neonates undergoing surgery are at greater risk of requiring packed red blood cell transfusion. Pediatric transfusion practices vary widely between countries and institutions, especially in the management of neonates. Aims: The aim of this study was to describe the use of intraoperative blood product transfusion during neonatal surgery in current clinical practice at our institution. Methods: A retrospective contextual, descriptive, and comparative study was conducted at Chris Hani Baragwanath Academic Hospital. A total of 1078 anesthetic records of neonates who underwent surgery from January 1, 2015 to December 31, 2019 were reviewed. Descriptive and inferential statistics were used to analyze the data. Results: Blood products were transfused during 374 (34.7%) neonatal surgeries. Packed red blood cells, platelet concentrate, and fresh frozen plasma were administered during 327 (30.3%), 133 (12.3%), and 85 (7.9%) of the total 1078 surgeries, respectively. The median (interquartile range) volume of packed red blood cells, fresh frozen plasma, platelets, and clear fluid administered was 15 (10–21.8) mL/kg, 12.3 (10–23.5) mL/kg, 13.6 (10–20.5) mL/kg, and 19 (9.1–28.8) mL/kg, respectively. Very low weight, low preoperative hemoglobin, long total anesthetic time, emergency surgery, and major surgery were independently associated with blood product transfusion. Gestational age at birth, blood product transfusion, emergency surgery, and major surgery were independently associated with the composite adverse outcomes. The median preoperative hemoglobin was 11.8 g/dL. Conclusions: Intraoperative blood product transfusion occurred at a much higher rate with a high median pre-transfusion hemoglobin compared to other studies.