Erythropoiesis is indicated by a reticulocyte count > 5%. When transfusing, consider
overall physiology and perfusion. Recall that transfusion will inhibit the marrow and
blunt the reticulocyte response
When transfusing in infants, use CMV-negative packed red blood cells.
Immunodeficient, preterm, and lymphopenic (<500/mm3) require CMV-negative
irradiated packed red blood cells 15 cc/kg over 3-4 hrs.
IV. CHRONIC LUNG DISEASE (CLD) / BRONCHOPULMONARY DYSPLASIA (BPD)
Chronic lung disease of prematurity (CLD), or bronchopulmonary dysplasia (BPD), is an
important cause of morbidity and mortality in the pre-term infant. The NIH consensus
definition of BPD defines it as the treatment of >21% oxygen for at least 28 days.
Further subclassification of severity is based on gestational age and chronologic age.
The incidence is 20% at those born <1500gm and 40% in those <1kg.
Contributing factors to CLD include prenatal exposures such as acute or chronic
maternal infection and smoking. Postnatal factors are related to immaturity such as
ventilator associated injury (oxygen toxicity, barotrauma/volutrama, atelectasis), sepsis,
pulmonary infection and poor nutrition. It is higher in males and there are likely genetic
factors.