title: Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants.
abstract: OBJECTIVE
  Recent reports have posited a temporal association between blood transfusion with packed red blood cells (BT) and necrotizing enterocolitis (NEC). We evaluated the relationship between BT and NEC among infants at three hospitals who were consented at birth into a prospective observational study of NEC.
  
  
  METHODS
  We used a case-control design to match each case of NEC in our study population of infants born at<33 weeks postmenstrual age (PMA) to one control infant using hospital of birth, PMA, birth weight and date of birth.
  
  
  RESULTS
  The number of transfusions per infant did not differ between 42 NEC cases and their controls (4.0 ± 4.6 vs 5.4 ± 4.1, mean ± s.d., P = 0.063). A matched-pair analysis did not identify an association of transfusion with NEC in either the 48-h or 7-day time periods before the onset of NEC. Stratifying on matched-sets, the Cox proportional hazard model did not identify any difference in the total number of BTs between the two groups (hazard ratio 0.78, 95% confidence interval 0.57 to 1.07, P = 0.11).
  
  
  CONCLUSIONS
  In contrast to previous studies, our case-control study did not identify a significant temporal association between BT and NEC. Additional large prospective randomized studies are needed to clarify the relationship between BT and NEC.
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Center for Health Equity and Quality Research, Department of Neurology, University of Florida College of Medicine, Jacksonville, FL, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Kraemer
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Torrazza
authors.affiliation: Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
authors.forename: V
authors.initials: V
authors.lastname: Mai
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Neu
authors.affiliation: Department of Epidemiology and Health Outcomes, Research Design and Analysis Program, Clinical and Translational Science Institute, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Shuster
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Hudak
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D008297:Male; D016555:Matched-Pair Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors