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.
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References
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364:255–64.
Neu J, Douglas-Escobar M, Lopez M. Microbes and the developing gastrointestinal tract. Nutr Clin Pract. 2007;22:174–82.
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.
Bishara N, Ohls RK. Current controversies in the management of the anemia of prematurity. Semin Perinatol. 2009;33:29–34.
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.
Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics. 2012;129:529–40.
Kirpalani H, Zupancic JA. Do transfusions cause necrotizing enterocolitis? The complementary role of randomized trials and observational studies. Semin Perinatol. 2012;36:269–76.
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.
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.
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.
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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
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DOI: https://doi.org/10.1007/s13312-015-0770-3