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

Context Reports 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. Objective Our 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. Design In 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. Setting A single regional perinatal centre in Memphis, Tennessee, USA. Patients 3060 ≤1500 g birth weights (BW) were included. Outcome measures The relative risk of developing NEC after exposure to a PRBC transfusion was measured. Results 3060 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). Conclusions Exposure 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.

[1]  F. Pulzer,et al.  Changes in regional tissue oxygenation saturation and desaturations after red blood cell transfusion in preterm infants , 2013, Journal of Perinatology.

[2]  BMJ Open , 2012 .

[3]  E. Bell,et al.  International survey of transfusion practices for extremely premature infants. , 2012, Seminars in perinatology.

[4]  J. Zupancic,et al.  Do transfusions cause necrotizing enterocolitis? The complementary role of randomized trials and observational studies. , 2012, Seminars in perinatology.

[5]  Adel Mohamed,et al.  Transfusion Associated Necrotizing Enterocolitis: A Meta-analysis of Observational Data , 2012, Pediatrics.

[6]  R. Whyte,et al.  Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. , 2011, The Cochrane database of systematic reviews.

[7]  J. Ioannidis,et al.  The False-positive to False-negative Ratio in Epidemiologic Studies , 2011, Epidemiology.

[8]  R. Locke,et al.  Increased Odds of Necrotizing Enterocolitis After Transfusion of Red Blood Cells in Premature Infants , 2011, Pediatrics.

[9]  M. El-Dib,et al.  Red blood cell transfusion, feeding and necrotizing enterocolitis in preterm infants , 2011, Journal of Perinatology.

[10]  M. Sutton,et al.  Transfusion-related acute gut injury: necrotizing enterocolitis in very low birth weight neonates after packed red blood cell transfusion. , 2011, The Journal of pediatrics.

[11]  D. Kent,et al.  Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants , 2011, Journal of Perinatology.

[12]  C. Hillyer,et al.  Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants? , 2010, The Journal of pediatrics.

[13]  T. Pysher,et al.  Is “transfusion‐associated necrotizing enterocolitis” an authentic pathogenic entity? , 2009, Transfusion.

[14]  T. Yanowitz,et al.  Blood transfusion alters the superior mesenteric artery blood flow velocity response to feeding in premature infants. , 2009, American journal of perinatology.

[15]  Julie Brown,et al.  Antenatal Corticosteroids for Accelerating Fetal Lung Maturation for Women at Risk of Preterm Birth , 2007, The Cochrane database of systematic reviews.

[16]  Ravi Mishra,et al.  Association of necrotizing enterocolitis with elective packed red blood cell transfusions in stable, growing, premature neonates. , 2006, American journal of perinatology.

[17]  C. Ince,et al.  The effect of storage time of human red cells on intestinal microcirculatory oxygenation in a rat isovolemic exchange model* , 2005, Critical care medicine.

[18]  M. Caplan,et al.  Neonatal Necrotizing Enterocolitis: Clinical Considerations and Pathogenetic Concepts , 2002, Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society.

[19]  R. Maier,et al.  Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g. , 2000, The Journal of pediatrics.

[20]  W. Sibbald,et al.  Transfusing red blood cells stored in citrate phosphate dextrose adenine-1 for 28 days fails to improve tissue oxygenation in rats. , 1997, Critical care medicine.

[21]  Robert M. Kliegman,et al.  Necrotizing Enterocolitis: Treatment Based on Staging Criteria , 1986, Pediatric Clinics of North America.