Skip to main content

Advertisement

Log in

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

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To determine if packed red blood cell transfusion is associated with onset of necrotizing enterocolitis, and whether withholding feed has any association with it.

Methods

Case records of 100 preterm neonates, (<34 weeks gestation) who developed necrotizing enterocolitis and 99 random age-and gestation-matched controls were evaluated for any blood transfusion 48 h before onset of necrotizing enterocolitis.

Results

During the study period 26% infants received packed red blood cell transfusion within 48-hours prior to onset of disease and 84% of these infants were not fed around the time of transfusion. Infants who developed necrotizing enterocolitis after transfusion were older, of lower gestational age, birth weight and more likely to develop stage 3 disease. They had a lower hematocrit at birth and before onset of disease and withholding feeds around transfusion did not prevent necrotizing enterocolitis. Odds of mortality in these infants was 2.83 (95% CI 0.97-8.9) and survivors had no significant difference in incidence of periventricular leukomalacia and length of hospital stay.

Conclusion

Blood Transfusion associated necrotizing enterocolitis is a severe, mainly surgical form of disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364:255–64.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  2. Neu J, Douglas-Escobar M, Lopez M. Microbes and the developing gastrointestinal tract. Nutr Clin Pract. 2007;22:174–82.

    Article  PubMed  Google Scholar 

  3. Christensen RD, Lambert DK, Henry E, Wiedmeier SE, Snow GL, Baer VL, et al. Is "transfusion-associated necrotizing enterocolitis" an authentic pathogenic entity? Transfusion. 2010;50:1106–12.

    Article  PubMed  Google Scholar 

  4. Bishara N, Ohls RK. Current controversies in the management of the anemia of prematurity. Semin Perinatol. 2009;33:29–34.

    Article  PubMed  Google Scholar 

  5. Josephson CD, Wesolowski A, Bao G, Sola-Visner MC, Dudell G, Castillejo MI, et al. Do red cell transfusions increase the risk of necrotizing enterocolitis in premature WHAT IS ALREADY KNOWN? • Onset of Necrotizing enterocolitis is preceded by blood transfusion in some cases and it leads to a severe form of disease with high morbidity and mortality. WHAT THIS STUDY ADDS? • Blood transfusion-associated Necrotizing enterocolitis seems to be a severe form of disease and withholding feedings around the time of transfusion does not seem to prevent this entity. infants? J Pediatr. 2010;157:972–8 e1-3.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.

    PubMed  CAS  Google Scholar 

  7. Mally P, Golombek SG, Mishra R, Nigam S, Mohandas K, Depalhma H, et al. Association of necrotizing enterocolitis with elective packed red blood cell transfusions in stable, growing, premature neonates. Am J Perinatol. 2006;23:451–8.

    Article  PubMed  Google Scholar 

  8. Blau J, Calo JM, Dozor D, Sutton M, Alpan G, La Gamma EF. Transfusion-related acute gut injury: necrotizing enterocolitis in very low birth weight neonates after packed red blood cell transfusion. J Pediatr. 2010;158:403–9.

    Article  PubMed  Google Scholar 

  9. Paul DA, Mackley A, Novitsky A, Zhao Y, Brooks A, Locke RG. Increased odds of necrotizing enterocolitis after transfusion of red blood cells in premature infants. Pediatrics. 2011;127:635–41.

    Article  PubMed  Google Scholar 

  10. Singh R, Visintainer PF, Frantz ID, Shah BL, Meyer KM, Favila SA, et al. Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants. J Perinatol. 2011;31:176–82.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  11. Amin SC, Remon JI, Subbarao GC, Maheshwari A. Association between red cell transfusions and necrotizing enterocolitis. J Matern Fetal Neonatal Med. 2012;25(Suppl 5):85–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stritzke AI, Smyth J, Synnes A, Lee SK, Shah PS. Transfusion-associated necrotising enterocolitis in neonates. Arch Dis Child Fetal Neonatal Ed. 2012; 2:445–567.

    Google Scholar 

  13. Bak SY, Lee S, Park JH, Park KH, Jeon JH. Analysis of the association between necrotizing enterocolitis and transfusion of red blood cell in very low birth weight preterm infants. Korean J Pediatr. 2013;56:112–5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wan-Huen P, Bateman D, Shapiro DM, Parravicini E. Packed red blood cell transfusion is an independent risk factor for necrotizing enterocolitis in premature infants. J Perinatol. 2013;33:786–90.

    Article  PubMed  CAS  Google Scholar 

  15. Gephart SM, Spitzer AR, Effken JA, Dodd E, Halpern M, McGrath JM. Discrimination of GutCheck (NEC): a clinical risk index for necrotizing enterocolitis. J Perinatol. 2014;34:468–75.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics. 2012;129:529–40.

    Article  PubMed  Google Scholar 

  17. Kirpalani H, Zupancic JA. Do transfusions cause necrotizing enterocolitis? The complementary role of randomized trials and observational studies. Semin Perinatol. 2012;36:269–76.

    Article  PubMed  Google Scholar 

  18. Sharma R, Kraemer DF, Torrazza RM, Mai V, Neu J, Shuster JJ, et al. Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants. J Perinatol. 2014;34:858–62.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Wallenstein MB, Arain YH, Birnie KL, Andrews J, Palma JP, Benitz WE, et al. Red blood cell transfusion is not associated with necrotizing enterocolitis: a review of consecutive transfusions in a tertiary neonatal intensive care unit. J Pediatr. 2014;165:678–82.

    Article  PubMed  Google Scholar 

  20. Viswanathan S, McNelis K, Super D, Einstadter D, Groh-Wargo S, Collin M. A Standardized slow enteral feeding protocol and the incidence of necrotizing enterocolitis in extremely low birth weight infants. J Parenter Enteral Nutr. 2015;39:644–54.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Prem S. Shekhawat.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garg, P.M., Ravisankar, S., Bian, H. et al. Relationship between packed red blood cell transfusion and severe form of necrotizing enterocolitis: A case control study. Indian Pediatr 52, 1041–1045 (2015). https://doi.org/10.1007/s13312-015-0770-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-015-0770-3

Keywords

Navigation