Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants?
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.
Josephson
Cassandra D
CD
Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, USA.
Wesolowski
Agnieszka
A
Bao
Gaobin
G
Sola-Visner
Martha C
MC
Dudell
Golde
G
Castillejo
Marta-Inés
MI
Shaz
Beth H
BH
Easley
Kirk A
KA
Hillyer
Christopher D
CD
Maheshwari
Akhil
A
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