title: Blood transfusions, increased rates of surgical NEC, and lower survival: a propensity score-matched analysis.
abstract: OBJECTIVE
  We sought to investigate the association between blood transfusions (BT), rates of necrotizing enterocolitis requiring surgical intervention (SNEC), and survival.
  
  
  METHODS
  Blood transfusions in premature infants were identified in the Kids' Inpatient Database (2003-2009). Propensity score-matched analysis compared SNEC outcomes in BT vs. non-BT groups. Multivariate analyses were performed to determine independent predictors of outcome.
  
  
  RESULTS
  Overall, 663740 cases were identified and 4.9% received BT. Surgical necrotizing enterocolitis occurred in 493 cases in the BT group, while SNEC occurred in 1049 cases in the non-BT group. Propensity score analysis of 20991 BT and 20988 non-BT cases demonstrated higher SNEC rates with BT (odds ratio [OR], 1.21) vs non-BT. Surgical necrotizing enterocolitis with BT had lower survival rates (58%) vs non-BT (67%). Surgical necrotizing enterocolitis with BT had lower length of stay and total charges vs non-BT. On multivariate analyses, SNEC mortality with BT increased for lower gestational age, males (OR, 45.7), African Americans (OR, 64.4), and infants with cardiac anomalies (OR, 50.8) or bronchopulmonary dysplasia (OR, 177). Non-BT SNEC demonstrated higher mortality with lower gestational age and infants with bronchopulmonary dysplasia (OR, 6.56) or sepsis (OR, 3.66).
  
  
  CONCLUSIONS
  On propensity score-matched analysis, SNEC occurs at higher rates after BT and is associated with lower survival and lower resource utilization vs SNEC without BT.
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Arash J
authors.initials: AJ
authors.lastname: Sayari
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. Electronic address: EPerez3@med.miami.edu.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
mesh_terms: D016208:Databases, Factual; D020345:Enterocolitis, Necrotizing / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D008297:Male; D016555:Matched-Pair Analysis; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D065227:Transfusion Reaction
keywords: Blood transfusion; Necrotizing enterocolitis; Neonatal prematurity