Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants

Patel, Ravi; Knežević, Andrea; Shenvi, Neeta; Hinkes, Michael T.; Keene, Sarah; Roback, John D.; Easley, Kirk A.; Josephson, Cassandra D.

doi:10.1001/jama.2016.1204

Cited by 244 publications

(243 citation statements)

References 24 publications

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“…Presumably, the strong association between GA and PDA may be the explanation of this detected difference in the overall cohort, since the cases were born at a significantly lower GA. The currently observed absence of an association between transfusions with erythrocytes and NEC is supported by findings in a recent prospective observational study [16]. The initiation of antibiotics within 24 h after birth was inversely associated with the development of NEC.…”

Section: Discussionmentioning

confidence: 66%

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

et al. 2018

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Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.

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Section: Discussionmentioning

confidence: 66%

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

et al. 2018

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“…However, no universally used Hb threshold for RBCT has been defined [6, 15], meaning that some infants are exposed to progressive anaemia which may result in gut hypoxia and injury [16]. …”

Section: Current Indicationsmentioning

confidence: 99%

“…Patel et al [16] looked at 598 VLBW infants and found that severe anaemia in a given week (defined as Hb < 8 g/dL), was associated with a significantly increased risk of NEC (adjusted cause-specific HR 5.99; 95% CI 2.00–18.00; p = 0.01) but not RBCT in a given week (adjusted cause-specific HR 0.44; 95% CI 0.17–1.12; p = 0.09). This is an important study as it involved large numbers, both of total recruited infants, and because 4,565 longitudinal measurements of Hb were evaluated.…”

Section: Anaemia Blood Transfusion and Necmentioning

confidence: 99%

Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies

2018

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The current evidence regarding the indication, advantages and risks of red blood cell transfusion (RBCT) for preterm infants is discussed. This is an important area in Neonatology to be examined given that 90% of extremely low birth weight infants receive RBCT and many controversies remain regarding when to transfuse and the risks of RBCT. The various treatment thresholds and guidelines used are presented and we compare the short-term clinical benefits of liberal and restrictive RBCT in preterm infants; the majority of these are equivocal and sadly long-term outcome data is limited. The latest evidence on how anaemia and blood transfusion affect organ perfusion in preterm infants is presented. This is important when trying to establish the optimal trigger threshold for RBCT in preterm infants, especially because the knowledge about the adaptive physiological responses to anaemia in very low birth weight infants and the effects of RBCT at various levels of anaemia is also inadequate. Further research into the physiological adaptive response to anaemia of varying degrees and to RBCT at different levels of anaemia in preterm infants of different gestational and post-natal ages is needed before we can conclusively guide the optimal timing and trigger thresholds for RBCT in preterm infants.

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“…While 2 reviews of the observational data disagreed in their conclusions [31, 32], a formal GRADE-based evaluation was skeptical of an association between transfusion and the putative existence of transfusion and NEC [33]. Moreover, a prospective large observational study demonstrated no excess risk of NEC in infants who are transfused, unless their prior hemoglobin was < 8 g/dL [34], suggesting the possible induction of a recirculation injury.…”

Section: New Reports Affecting the Balance Of The Risk:benefit Ratiomentioning

confidence: 99%

What Is New about Transfusions for Preterm Infants? An Update

Kirpalani

Whyte

2019

Neonatology

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Currently the question of whether to maintain a higher hemoglobin level by transfusing more liberally, as opposed to a more restrictive strategy with lower hemoglobin maintenance levels, has not been answered. We review summarized conclusions of a Cochrane systematic review and meta-analysis of 614 infants in 4 randomized controlled trials (RCT) pooling data. This suggests potential benefits of higher hemoglobin levels, i.e., a possible improved cognition of infants at 18–21 months’ corrected age and a reduction of apnea. However, the data on cognition is hypothesis generating as it derives from a post hoc analysis from a single trial in 451 infants. Moreover, the data on apnea need confirmation in larger trials. The effect of adding data of cognitive 2-year outcomes of 1,744 infants from 2 RCT, which will be reported soon, should expand our understanding. This new data will need to be integrated with the older generation of RCTs but also with emerging suggestions from observational data on potential risks of blood transfusions. We discuss some of these warnings from observational studies. Finally, we ask whether we are ready to individualize blood transfusion to physiological measures made in individual infants, and we point to some current difficulties hindering this step.

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Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants

Cited by 244 publications

References 24 publications

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies

What Is New about Transfusions for Preterm Infants? An Update

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