More than half of very-low-birth-weight (VLBW) infants receive RBC transfusions. The prospective cohort Transfusion in Preterm Infants (TIPI) study was designed to identify RBC characteristics associated with poor transfusion outcomes in VLBW infants. Between 2019 and 2023, 2605 VLBW infants born at 8 U.S. hospitals participating in the Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) study were enrolled. The 1283 infants who received at least one RBC transfusion had lower median gestational ages and birth weights (26.6 weeks and 820 g) than those who were not transfused (30.6 weeks and 1270 g). Two-thirds of the infants transfused experienced severe morbidity (intraventricular hemorrhage, necrotizing enterocolitis, late-onset sepsis, severe bronchopulmonary dysplasia, retinopathy of prematurity) or mortality—the composite primary outcome. Of note, about 25% of infants with the primary outcome were transfused at hemoglobin levels greater than 11 g/dL. Based on the multivariate analysis, higher pretransfusion hemoglobin levels were associated with increased odds of the composite primary outcome (odds ratio per 1 g/dL increase, 1.15; 95% C.I., 1.07 to 1.25; p<0.001), and the use of additive solution (AS)-1 or AS-5 was associated with lower odds of the composite outcome compared with citrate phosphate dextrose adenine or citrate phosphate dextrose (OR, 0.72; 95% C.I., 0.53 to 0.97; p=0.03). Age and sex of donor nor storage time for RBCs affected the composite primary outcome. Further studies are needed to explore the effects of storage solution and transfusion outcomes.
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