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This study aimed to determine the adverse outcomes of RBCTs in very low birth weight infants (VLBWI) at a resource\u2010restricted hospital in Cape Town, South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>A retrospective descriptive analysis of all VLBWI who received a RBCT in 2020 was performed. Univariate and multivariate logistic regression were performed to determine the association of adverse events after single, multiple, early, and late RBCTs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study cohort included 178 VLBWI, representing a RBCT prevalence of 22.2%. The mean gestational age was 28\u2009weeks and the mean birth weight was 0.99\u2009kg. The first RBCT occurred at a mean of 27\u2009days and at an Hb\u2009&lt;8\u2009g\/dL, differing significantly between single, multiple early, and late RBCT groups. After adjusting for confounders, multiple RBCTs showed a strong association with TR\u2010LOS within 3\u2009days (aOR 9.22, 95th CI 2.30; 36.91, <jats:italic>p<\/jats:italic>\u2009=\u2009.002), TR\u2010LOS within 7\u2009days (aOR 8.39, 95th CI 2.72; 25.89, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), any NEC \u2265 Bell stage 2 (aOR 2.34, 95th CI 1.66; 11.78, <jats:italic>p<\/jats:italic>\u2009=\u2009.026), BPD (aOR 3.62, 95th CI 1.37; 9.54, <jats:italic>p<\/jats:italic>\u2009=\u2009.009) and mortality (aOR 3.58, 95th CI 1.39; 9.22, <jats:italic>p<\/jats:italic>\u2009=\u2009.008). After adjusting for confounders, early RBCTs were strongly associated with mortality (aOR 2.47, 95th CI 1.28; 8.90, <jats:italic>p<\/jats:italic>\u2009=\u2009.013).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Multiple RBCTs may be associated with TR\u2010related sepsis. This requires more research in resource\u2010restricted areas with a high burden of disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.18244","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T08:29:26Z","timestamp":1744014566000},"page":"897-908","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Adverse outcomes after red blood cell transfusion in very low birth weight infants in a resource\u2010restricted hospital"],"prefix":"10.1111","volume":"65","author":[{"given":"Ashish","family":"Madhou","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health Stellenbosch University  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lizel G.","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Stellenbosch University  Cape Town South 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