Association of Necrotizing Enterocolitis with Elective Packed Red Blood Cell Transfusions in Stable, Growing, Premature Neonates

Abstract

The purpose of this study was to determine an association between packed red blood cell (PRBC) transfusions for anemia and necrotizing enterocolitis (NEC) in a subset of stable, growing, premature neonates. As part of a survey of current clinical practices over a 17-month period from June 1999 to October 2000, a chart review was performed to determine the relationship between elective PRBC transfusions and the occurrence of NEC. Demographic data were tabulated and compared between the NEC patients with a prior history of immediate blood transfusion (within 48 hours of onset of symptoms) and those NEC patients without a prior history of immediate blood transfusion. A total of 908 (inborn) neonatal admissions had received 751 PRBC transfusions during the study period; of these, 17 patients (1.8%) had developed radiographic, clinical, or surgical signs of NEC. Six cases of NEC (35%; six of 17 patients) were associated with PRBC transfusions (0.8%; six of 751 transfusions). The transfusion-associated NEC group developed presenting signs within 22 +/- 5 hours (median, 19; range, 12 to 38) of a PRBC transfusion at a mean age of 32 +/- 7 days. In contrast, the non-transfusion-associated NEC group (n = 11) had onset of NEC at a mean age of 12 +/- 7 days ( P < 0.05) after 185 +/- 91 hours (median, 180; range, 96 to 312; P < 0.02] of a transfusion. Prior to the onset of NEC, all of the neonates in the transfusion-associated NEC group were stable, growing, not ventilated, receiving full enteral feedings, and had no other active medical problems except anemia (hematocrit, 24 +/- 3%). In contrast, the nontransfusion NEC group was more often ventilated, was receiving < 50% of fluids by mouth, had lower Apgar scores, and was transfused for an average hematocrit of 37 +/- 7% ( P < 0.05). There was no significant difference in the type, storage, volume, or preservative used between the blood products in the two groups. We identified an unanticipated relationship between late-onset NEC in stable, growing, premature neonates who were transfused electively for anemia of prematurity.

Red blood cell transfusion, feeding and necrotizing enterocolitis in preterm infants

“…12 The association between NEC and red blood cell (RBC) transfusion has been a subject of recent debate. [13][14][15][16][17] On the basis of this presumptive association between RBC transfusion and NEC, some NICUs have set their policy to avoid feeding during transfusion. 18 A recent study demonstrated that transfusion negatively affects the post-prandial increase in mesenteric blood flow.…”

Risk factors for necrotizing enterocolitis totalis: a case–control study

“…Other studies have noted a similar 27,28 However, the nature of this association remains to be fully explored; it is unclear that this is truly a causative relationship. It is possible that patients who are beginning to manifest systemic signs of illness are more likely to have laboratory tests performed and perhaps a lowered transfusion threshold is applied.…”

Quality Improvement Initiative to Reduce the Necrotizing Enterocolitis Rate in Premature Infants

“…[27][28][29] To this end, the conservative feeding transfusion policy of holding feeds and/or not changing volume or fortification on the same day as a transfusion was felt to be of low risk and potentially high benefit to the reduction of the incidence of NEC. Despite the overall decrease use of indomethacin therapy for hemodynamically significant patent ductus arteriosus, we instituted a conservative feeding guideline to ensure use of a standardized feeding regimen in our neonatal network.…”