Effect of birth weight on the association between necrotising enterocolitis and red blood cell transfusions in ≤1500 g infants

Abstract

ContextReports evaluating a possible association between necrotising enterocolitis (NEC) and blood transfusion have been predominantly case–control studies. As the possible associations of disease with any variable on which cases and controls have been matched cannot be explored, a cohort study would offer a solution to this problem.ObjectiveOur objective was to evaluate the association between exposure to a packed red blood cell (PRBC) transfusion and development of NEC in a cohort where biases of matching are omitted.DesignIn a retrospective cohort, exposed infants were defined as those who received a transfusion and did not develop NEC or developed NEC within 48 h of the transfusion. All others were considered unexposed.SettingA single regional perinatal centre in Memphis, Tennessee, USA.Patients3060 ≤1500 g birth weights (BW) were included.Outcome measuresThe relative risk of developing NEC after exposure to a PRBC transfusion was measured.Results3060 infants were identified. 174 infants (5.7%) developed NEC; 116 of the 174 infants (67%) were exposed. NEC infants had a significantly lower BW (924 vs 1042 g) and required a longer stay on a ventilator (7 vs 2 days). Divided into groups, infants with BW ≤750 , 751–1000 , 1001–1250 g and 1251–1500 g (n=52, 51, 46 and 25, respectively) had a relative risk of 0.14, 0.46, 1.83 and 1.78 (p<0.01, 0.02, 0.07 and 0.17), respectively, to develop NEC after an exposure. Infants with longest ventilator days were also significantly less likely to develop NEC after an exposure; relative risk=0.11 (p<0.01).ConclusionsExposure to transfusions was less likely associated with NEC in ≤1000 g infants and remained a risk factor in 1001–1500 infants. BW has to be factored in any study evaluating the association between PRBC transfusions and NEC.

Surgical Findings in Transfusion-Associated Necrotizing Enterocolitis

“…15,16 According to other works, it is generally accepted that premature neonates with TNEC have lower gestational ages, lower birth weights, and a late age of presentation (approximately 3 or 4 weeks after birth). 4,11,12,[17][18][19] The first statements were confirmed in the present research; on the contrary, the age at diagnosis was lower in the patients of this sample: 13 days in TR48. This investigation only included neonates who underwent surgical treatment for NEC: their age of presentation was similar to data published by Najaf (14 days at presentation of symptoms) and higher than the result given by Zhang (5.24 days at admission because of NEC) who performed studies which considered exclusive cases of NEC which received surgical therapy.…”

“…Although Mally reported a series of six healthy, stable neonates developing a fulminant form of NEC after receiving a RBCT, most works indicate that patients with TNEC are usually in worse clinical conditions before the onset of NEC. 3,4,12,18 Thus, an accurate adjustment for clinical variables related to common comorbidities of low-birth-weight neonates is mandatory when investigations about TNEC show poorer outcomes in these patients. This adjustment was not performed in this work because there were no differences in major outcomes between the neonates classified as TNEC and those from group CN.…”

Red Blood Cell Transfusion Is Not Associated with Necrotizing Enterocolitis: A Review of Consecutive Transfusions in a Tertiary Neonatal Intensive Care Unit

“…Multiple retrospective cohort and case control studies have demonstrated an association between pRBC transfusion and subsequent development of NEC, 11-24 although 2 of these studies reported mixed results. 18,24 The risk of developing TA-NEC is reported to be 5-17 per 1000 transfusion events, accounting for 27%-38% of all NEC cases.…”

“…18,24 The risk of developing TA-NEC is reported to be 5-17 per 1000 transfusion events, accounting for 27%-38% of all NEC cases. 11,12,14,15,18 These observational studies have led to the growing acceptance of TA-NEC as a valid clinical entity.…”

Martwicze zapalenie jelit związane z przetoczeniem krwi (TANEC) u noworodka ze skrajnie małą urodzeniową masą ciała (ELBW) – opis przypadku

“…Harsono i wsp. [11] wykazali protekcyjne działanie transfuzji uzupełniającej na wystąpie-nie NEC. W kolejnej pracy z 2013 r. autorzy ci wykazali, że transfuzja NUKKCZ zmniejsza ryzyko wystąpienia NEC, szczególnie w grupie najciężej chorych ELBW (analizowano m.in.…”