Transfusion-related Gut Injury and Necrotizing Enterocolitis

Rose, Allison T.; Saroha, Vivek; Patel, Ravi

doi:10.1016/j.clp.2020.02.002

Cited by 14 publications

(15 citation statements)

References 61 publications

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“…The background of this pathophysiological process remains elusive, as patients with severe NEC might develop bleeding and anemia and, therefore, require RBC transfusions. Moreover, larger meta-analyses were not able to confirm this association [28]. We included RBC transfusion up until 5 days before diagnosis of NEC in our analysis, and we confirmed that RBC transfusions were independently associated with Bell stage III, but did not further investigate the underlying processes.…”

Section: Discussionmentioning

confidence: 79%

Prediction of High Bell Stages of Necrotizing Enterocolitis Using a Mathematic Formula for Risk Determination

et al. 2022

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Necrotizing enterocolitis (NEC) continues to cause high morbidity and mortality. Identifying early predictors for severe NEC is essential to improve therapy and optimize timing for surgical intervention. We present a retrospective study of patients with NEC, treated between 2010 and 2020, trying to identify factors influencing the severity of NEC. Within the study period, 88 affected infants with NEC or NEC-like symptoms are analyzed. A multiple logistic regression analysis reveals the following three independent predictors for NEC in Bell stage III: red blood cell transfusion (p = 0.027 with odds ratio (OR) = 3.298), sonographic findings (p = 0.037; OR = 6.496 for patients with positive vs. patients without pathological findings) and cardiac anatomy (p = 0.015; OR = 1.922 for patients with patent ductus arteriosus (PDA) vs. patients with congenital heart disease (CHD); OR = 5.478/OR = 2.850 for patients with CHD/PDA vs. patients without cardiac disease). Results are summarized in a clinical score for daily application in clinical routine. The score is easy to apply and combines clinically established parameters, helping to determine the timing of surgical intervention.

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Section: Discussionmentioning

confidence: 79%

Prediction of High Bell Stages of Necrotizing Enterocolitis Using a Mathematic Formula for Risk Determination

et al. 2022

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“…Preterm infants who develop transfusion-associated NEC are at a higher risk of mortality, and surgical NEC is more prevalent following PRBC transfusion [ 19 , 20 , 21 ]. Furthermore, recent data suggest that severe anemia may influence the risk of gut injury [ 22 ]; therefore, following care approaches such as delayed cord clamping and reducing blood loss due to phlebotomy are suggested [ 23 ]. In our study, the incidence of confirmed NEC was significantly lower in the study group compared to the control group.…”

Section: Discussionmentioning

confidence: 99%

Effect of Small Volume Blood Sampling on the Outcomes of Very Low Birth Weight Preterm Infants

Chung

Yang

et al. 2022

Children

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Very low birth weight (VLBW) preterm infants universally experience anemia of prematurity (AOP) while growing up. The effects of reduced blood sample volume on AOP, packed red blood cell (PRBC) transfusion, and outcome in VLBW preterm infants were examined in this study. To reduce blood loss due to phlebotomy, we set up a small volume blood sampling procedure in VLBW infants. In this retrospective study, we compared the VLBW infants who had undergone standard blood sampling (control group, n = 20) with those who underwent small volume blood sampling (study group, n = 84), with both groups receiving PRBC transfusion under restrictive criteria. Blood loss from phlebotomy and PRBC transfusion volume over 30 days was significantly lower in the study group than in the control group. Compared to the control group, hematocrit, reticulocyte, and iron levels were significantly higher in the study group. There were no significant differences in the proportion of patent ductus arteriosus, severe intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia between the two groups. The small volume blood sampling resulted in lower PRBC transfusion volume, less severe anemia, and greater bone marrow function at 30 days of age. This strategy can reduce potential adverse effects of PRBC transfusion in VLBW preterm infants.

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“…Herein, we proposed that anemia, rather than blood transfusion, increased the risk of NEC occurrence in patients without sepsis because anemia damages splanchnic perfusion and causes hypoxia, anaerobic metabolism, and accumulation of anaerobic metabolism products, such as lactic acids. These by-products disrupt the intestinal vascular regulation and result in ischemic injury, thereby increasing the risk of NEC occurrence 35 . Various microbes causing sepsis give rise to anemia, hypoxia, and intestinal tissue damage in the body, and hence, are deemed as confounding factors that complicate the analysis of the results.…”

Section: Correlation Between Plt Activation Indicators and Nec Occurrencementioning

confidence: 99%

Association of anemia and platelet activation with necrotizing enterocolitis with or without sepsis among low birth weight neonates: a case–control study

Jiang

Zhang

2022

Preprint

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To evaluate the value of the proportion of large platelets (PLCR) and platelet crit (PCT) in predicting necrotizing enterocolitis (NEC) in low birth weight (LBW) neonates.A total of 155 LBW (< 2500 g) neonates with NEC admitted to the neonatal intensive care unit (NICU) of the hospital from January 1, 2017 to November 30, 2019 were included in the case group. According to the 1:3 case-control study design, a total of 465 LBW neonates without NEC (3 for each LBW neonate with NEC) in the NICU born ≤ 24 h before or after the birth of the cases were included in the control group.During the study period, a total of 6946 LBW neonates were born, and 155 had NEC, including 98 who also had sepsis. Neonatal sepsis was the most important risk factor and confounding factor for NEC in LBW neonates. Further stratified analysis of the sepsis showed that in LBW neonates without sepsis, anemia, high PLCR, and high PCT increases the risk of NEC, and the receiver operating characteristic curve area of PLCR was 0.739, the sensitivity was 0.770, the specificity was 0.610, and the cutoff value was 33.55.Conclusion: The data showed that 2/100 LBW neonates were prone to NEC, and stratified analysis of confounding factors of sepsis identified the risk factors of NEC in LBW neonates. This study first reported the significant value of PLCR in the early prediction of NEC occurrence in LBW neonates without sepsis.

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Transfusion-related Gut Injury and Necrotizing Enterocolitis

Cited by 14 publications

References 61 publications

Prediction of High Bell Stages of Necrotizing Enterocolitis Using a Mathematic Formula for Risk Determination

Prediction of High Bell Stages of Necrotizing Enterocolitis Using a Mathematic Formula for Risk Determination

Effect of Small Volume Blood Sampling on the Outcomes of Very Low Birth Weight Preterm Infants

Association of anemia and platelet activation with necrotizing enterocolitis with or without sepsis among low birth weight neonates: a case–control study

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