Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants

Abstract

OBJECTIVE Recent reports have posited a temporal association between blood transfusion with packed red blood cells (BT) and necrotizing enterocolitis (NEC). We evaluated the relationship between BT and NEC among infants at three hospitals who were consented at birth into a prospective observational study of NEC. STUDY DESIGN We used a case–control design to match each case of NEC in our study population of infants born at <33 weeks postmenstrual age (PMA) to one control infant using hospital of birth, PMA, birth weight and date of birth. RESULT The number of transfusions per infant did not differ between 42 NEC cases and their controls (4.0 ± 4.6 vs 5.4 ± 4.1, mean ± s.d., P = 0.063). A matched-pair analysis did not identify an association of transfusion with NEC in either the 48-h or 7-day time periods before the onset of NEC. Stratifying on matched-sets, the Cox proportional hazard model did not identify any difference in the total number of BTs between the two groups (hazard ratio 0.78, 95% confidence interval 0.57 to 1.07, P = 0.11). CONCLUSION In contrast to previous studies, our case–control study did not identify a significant temporal association between BT and NEC. Additional large prospective randomized studies are needed to clarify the relationship between BT and NEC.

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

“…These findings are in contrast to the published systematic review and meta-analysis of 12 retrospective studies that demonstrated an association between RBC transfusion and NEC 4 but a reconsistent with those of Sharma et al, 6 which indicated that RBC transfusion was not associated with the cumulative incidence of NEC. By evaluating each RBC transfusion exposure during hospitalization using time-varying covariates, the results of this study may be less subject to the biases of prior studies in which each infant was categorized as exposed or unexposed to any RBC transfusion or in which temporality between exposure and outcome was not evaluated.…”

“…A meta-analysis of retrospective observational studies demonstrated an association between exposure to RBC transfusion and NEC, with receipt of RBC transfusion being associated with an increased risk of NEC (adjusted odds ratio, 2.0 [95% CI, 1.6-2.5]). 4 However, more recent observational studies have found no association between RBC transfusion and NEC 5,6 or have found RBC transfusion to be protective. 7,8 In addition, a meta-analysis of randomized trials reported no difference in the incidence of NEC between infants receiving conservative vs liberal RBC transfusion approaches (pooled odds ratio, 1.67 [95% random-effects CI, 0.82-3.38]).…”

Relationship between packed red blood cell transfusion and severe form of necrotizing enterocolitis: A case control study

“…A more recent meta-analysis has been more cautious in reaching the same conclusion [17]. On the other hand, two recent reports did not find PRBC transfusion as a risk factor for NEC [18,19]. Some investigators have reported a significant decrease in the overall NEC rate following the institution of a policy of withholding enteral feedings during and after PRBC transfusion [20].…”

Red blood cell transfusion in premature infants leads to worse necrotizing enterocolitis outcomes

“…3, 4 The pathophysiology of NEC is not completely understood; however, research suggests a multifactorial etiology with no single definitive cause. Early, retrospective studies evaluating the administration of red blood cell (RBC) transfusion in neonates demonstrated an increased risk of NEC after RBC transfusion, 5–8 while more recent studies have reported no association 9, 10 or even protection from NEC after receipt of RBC transfusion. 11, 12 A recent secondary, prospective analysis performed by Patel et al concluded that severe anemia, rather than RBC transfusion, was actually the factor associated with an increased risk of NEC.…”