title: Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants?
abstract: OBJECTIVE
  To test the hypothesis that red blood cell (RBC) transfusions increase the risk of necrotizing enterocolitis (NEC) in premature infants, we investigated whether the risk of "transfusion-associated" NEC is higher in infants with lower hematocrits and advanced postnatal age.
  
  
  METHODS
  Retrospective comparison of NEC patients and control patients born at < 34 weeks gestation.
  
  
  RESULTS
  The frequency of RBC transfusions was similar in NEC patients (47/93, 51%) and control patients (52/91, 58%). Late-onset NEC (> 4 weeks of age) was more frequently associated with a history of transfusion(s) than early-onset NEC (adjusted OR, 6.7; 95% CI, 1.5 to 31.2; P = .02). Compared with nontransfused patients, RBC-transfused patients were born at earlier gestational ages, had greater intensive care needs (including at the time of onset of NEC), and longer hospital stay. A history of RBC transfusions within 48-hours before NEC onset was noted in 38% of patients, most of whom were extremely low birth weight infants.
  
  
  CONCLUSIONS
  In most patients, RBC transfusions were temporally unrelated to NEC and may be merely a marker of overall severity of illness. However, the relationship between RBC transfusions and NEC requires further evaluation in extremely low birth weight infants using a prospective cohort design.
authors.affiliation: Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Josephson
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Wesolowski
authors.forename: Gaobin
authors.initials: G
authors.lastname: Bao
authors.forename: Martha C
authors.initials: MC
authors.lastname: Sola-Visner
authors.forename: Golde
authors.initials: G
authors.lastname: Dudell
authors.forename: Marta-Inés
authors.initials: MI
authors.lastname: Castillejo
authors.forename: Beth H
authors.initials: BH
authors.lastname: Shaz
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Easley
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Hillyer
authors.forename: Akhil
authors.initials: A
authors.lastname: Maheshwari
mesh_terms: D016022:Case-Control Studies; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology* / Q000209:etiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors