title: Feeding practices and other risk factors for developing transfusion-associated necrotizing enterocolitis.
abstract: OBJECTIVE
  The objective of this study is to determine the incidence of and risk factors for necrotizing enterocolitis (NEC) and transfusion-associated NEC (TANEC) in very-low-birth-weight (VLBW) infants pre/post implementation of a peri-transfusion feeding protocol.
  
  
  METHODS
  A retrospective cohort study was conducted including all inborn VLBW infants admitted to the Duke intensive care nursery from 2002 to 2010. We defined NEC using Bell's modified criteria IIA and higher and TANEC as NEC occurring within 48h of a packed red blood cell (pRBC) transfusion. We compared demographic and laboratory data for TANEC vs. other NEC infants and the incidence of TANEC pre/post implementation of our peri-transfusion feeding protocol. We also assessed the relationship between pre-transfusion hematocrit and pRBC unit age with TANEC.
  
  
  RESULTS
  A total of 148/1380 (10.7%) infants developed NEC. Incidence of NEC decreased after initiating our peri-transfusion feeding protocol: 126/939 (12%) to 22/293 (7%), P=0.01. The proportion of TANEC did not change: 51/126 (41%) vs. 9/22 (41%), P>0.99. TANEC infants were smaller, more likely to develop surgical NEC, and had lower mean pre-transfusion hematocrits prior to their TANEC transfusions compared with all other transfusions before their NEC episode: 28% vs. 33%, P<0.001. Risk of TANEC was inversely related to pre-transfusion hematocrit: odds ratio 0.87 (0.79-0.95).
  
  
  CONCLUSIONS
  Pre-transfusion hematocrit is inversely related to risk of TANEC, which suggests that temporally maintaining a higher baseline hemoglobin in infants most at risk of NEC may be protective. The lack of difference in TANEC pre-/post-implementation of our peri-transfusion feeding protocol, despite an overall temporal decrease in NEC, suggests that other unmeasured interventions may account for the observed decreased incidence of NEC.
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States.
authors.forename: Chris
authors.initials: C
authors.lastname: Derienzo
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States; Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States.
authors.forename: David
authors.initials: D
authors.lastname: Tanaka
authors.affiliation: Duke University Transfusion Services, Durham, NC, United States.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bandarenko
authors.affiliation: Duke University Transfusion Services, Durham, NC, United States.
authors.forename: Mary Lee
authors.initials: ML
authors.lastname: Campbell
authors.affiliation: Duke University Transfusion Services, Durham, NC, United States.
authors.forename: Annadele
authors.initials: A
authors.lastname: Herman
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States.
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States. Electronic address: michael.cotten@dm.duke.edu.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
mesh_terms: D001804:Blood Transfusion, Autologous / Q000009:adverse effects*; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005247:Feeding Behavior; D005260:Female; D005865:Gestational Age; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Anemia; Feeding; Necrotizing enterocolitis; Transfusion; Very low birth weight infants