Abstract
BackgroundThe effect of red blood cell (RBC) transfusion on retinopathy of prematurity (ROP) is difficult to establish, because ROP may also be influenced by other factors. Therefore, we carried out a systematic review and meta-analysis to explore the relationship between RBC transfusion and the development of ROP.MethodsThe PubMed, Embase, Cochrane Library and Web of Science databases were searched from their inception to September 1, 2019. Observational studies that reported the relationship between RBC transfusion and ROP after adjusting for other potential risk factors were included. The combined result was analyzed by a random effect model. Heterogeneity and publication bias were tested, and sensitivity analysis was performed.ResultsOf the 2628 identified records, 18 studies including 15072 preterm infants and 5620 cases of ROP were included. A random effect model was used and revealed that RBC transfusion was significantly associated with ROP (pooled OR = 1.50, 95% CI: 1.27–1.76), with moderate heterogeneity among the included studies (I2 = 44.2%). Subgroup analysis indicated that RBC transfusion was more closely related to ROP in the group with a gestational age (GA) ≤32 weeks (OR = 1.77, 95% CI: 1.29–2.43) but not in the groups with a GA ≤34 weeks (OR = 1.36, 95% CI: 0.85–2.18) or a GA <37 weeks (OR = 1.25, 95% CI: 0.86–1.82). No obvious publication bias was found based on the funnel plot and Egger’s test. Removing any single study did not significantly alter the combined result in the sensitivity analysis.ConclusionsOur study revealed that RBC transfusion is an independent risk factor for the development of ROP, especially in younger preterm infants. However, there seemed to be no evidence to support an effect of RBC transfusion on ROP in older groups. Further studies addressing this issue in older preterm neonates are warranted.
Highlights
Retinopathy of prematurity (ROP) is a vasoproliferative disorder affecting the retinas of preterm infants and is the leading cause of childhood blindness worldwide [1]
A random effect model was used and revealed that red blood cell (RBC) transfusion was significantly associated with ROP, with moderate heterogeneity among the included studies (I2 = 44.2%)
Subgroup analysis indicated that RBC transfusion was more closely related to ROP in the group with a gestational age (GA) 32 weeks (OR = 1.77, 95% confidence interval (CI): 1.29–2.43) but not in the groups with a GA 34 weeks (OR = 1.36, 95% CI: 0.85–2.18) or a GA
Summary
Retinopathy of prematurity (ROP) is a vasoproliferative disorder affecting the retinas of preterm infants and is the leading cause of childhood blindness worldwide [1]. ROP is affected by multiple factors, such as maternal, perinatal, infant and treatment factors, and among these factors, red blood cell (RBC) transfusion may play an important role [2]. Considerable evidence suggests that RBC transfusion is related to several preterm disorders, including the development of ROP [5]. Other studies did not identify a close relationship between RBC transfusion and ROP, especially after adjusting for other risk factors [7, 8]. The effect of red blood cell (RBC) transfusion on retinopathy of prematurity (ROP) is difficult to establish, because ROP may be influenced by other factors.
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