• Jennifer A Muszynski, Russell Banks, Ron W Reeder, Mark W Hall, Robert A Berg, Athena Zuppa, Thomas P Shanley, Timothy T Cornell, NewthChristopher J LCJLDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California., Murray M Pollack, David Wessel, Allan Doctor, John C Lin, Rick E Harrison, Kathleen L Meert, J Michael Dean, Richard Holubkov, Joseph A Carcillo, and Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN).
• Division of Critical Care, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
• Shock. 2022 Jan 1; 57 (1): 889488-94.

BackgroundLittle is known about the epidemiology of and outcomes related to red blood cell (RBC) transfusion in septic children across multiple centers. We performed propensity-adjusted secondary analyses of the Biomarker Phenotyping of Pediatric Sepsis and Multiple Organ Failure (PHENOMS) study to test the hypothesis that early RBC transfusion is associated with fewer organ failure-free days in pediatric severe sepsis.MethodsFour hundred one children were enrolled in the parent study. Children were excluded from these analyses if they received extracorporeal membrane oxygenation (n = 22) or died (n = 1) before sepsis day 2. Propensity-adjusted analyses compared children who received RBC transfusion on or before sepsis day 2 (early RBC transfusion) with those who did not. Logistic regression was used to model the propensity to receive early RBC transfusion. A weighted cohort was constructed using stabilized inverse probability of treatment weights. Variables in the weighted cohort with absolute standardized differences >0.15 were added to final multivariable models.ResultsFifty percent of children received at least one RBC transfusion. The majority (68%) of first transfusions were on or before sepsis day 2. Early RBC transfusion was not independently associated with organ failure-free (-0.34 [95%CI: -2, 1.3] days) or PICU-free days (-0.63 [-2.3, 1.1]), but was associated with the secondary outcome of higher mortality (aOR 2.9 [1.1, 7.9]).ConclusionsRBC transfusion is common in pediatric severe sepsis and may be associated with adverse outcomes. Future studies are needed to clarify these associations, to understand patient-specific transfusion risks, and to develop more precise transfusion strategies.Copyright © 2021 by the Shock Society.

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