title: Association of necrotizing enterocolitis with elective packed red blood cell transfusions in stable, growing, premature neonates.
abstract: The purpose of this study was to determine an association between packed red blood cell (PRBC) transfusions for anemia and necrotizing enterocolitis (NEC) in a subset of stable, growing, premature neonates. As part of a survey of current clinical practices over a 17-month period from June 1999 to October 2000, a chart review was performed to determine the relationship between elective PRBC transfusions and the occurrence of NEC. Demographic data were tabulated and compared between the NEC patients with a prior history of immediate blood transfusion (within 48 hours of onset of symptoms) and those NEC patients without a prior history of immediate blood transfusion. A total of 908 (inborn) neonatal admissions had received 751 PRBC transfusions during the study period; of these, 17 patients (1.8%) had developed radiographic, clinical, or surgical signs of NEC. Six cases of NEC (35%; six of 17 patients) were associated with PRBC transfusions (0.8%; six of 751 transfusions). The transfusion-associated NEC group developed presenting signs within 22 +/- 5 hours (median, 19; range, 12 to 38) of a PRBC transfusion at a mean age of 32 +/- 7 days. In contrast, the non-transfusion-associated NEC group (n = 11) had onset of NEC at a mean age of 12 +/- 7 days ( P < 0.05) after 185 +/- 91 hours (median, 180; range, 96 to 312; P < 0.02] of a transfusion. Prior to the onset of NEC, all of the neonates in the transfusion-associated NEC group were stable, growing, not ventilated, receiving full enteral feedings, and had no other active medical problems except anemia (hematocrit, 24 +/- 3%). In contrast, the nontransfusion NEC group was more often ventilated, was receiving < 50% of fluids by mouth, had lower Apgar scores, and was transfused for an average hematocrit of 37 +/- 7% ( P < 0.05). There was no significant difference in the type, storage, volume, or preservative used between the blood products in the two groups. We identified an unanticipated relationship between late-onset NEC in stable, growing, premature neonates who were transfused electively for anemia of prematurity.
authors.affiliation: Division of Neonatology, New York University School of Medicine, New York, NY 10016, USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Mally
authors.forename: Sergio G
authors.initials: SG
authors.lastname: Golombek
authors.forename: Ravi
authors.initials: R
authors.lastname: Mishra
authors.forename: Sarvesh
authors.initials: S
authors.lastname: Nigam
authors.forename: Kala
authors.initials: K
authors.lastname: Mohandas
authors.forename: Helene
authors.initials: H
authors.lastname: Depalhma
authors.forename: Edmund F
authors.initials: EF
authors.lastname: LaGamma
mesh_terms: D000751:Anemia, Neonatal / Q000628:therapy; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D018571:Sentinel Surveillance