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Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants

Journal of Perinatology volume 34, pages 858–862 (2014)Cite this article

Subjects

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.

Study Design:

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.

Result:

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).

Conclusion:

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.

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Acknowledgements

This work was supported in part by the National Institute of Child Health and Human Development Grant RO1 HD059143 and in part by the National Center for Advancing Clinical and Translational Sciences Grant 1UL1TR000064.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA

    R Sharma & M L Hudak

  2. Department of Neurology, Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, FL, USA

    D F Kraemer

  3. Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA

    R M Torrazza & J Neu

  4. Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA

    V Mai

  5. 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

    J J Shuster

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Correspondence to M L Hudak.

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Appendix Transfusion guidelines in the study population

Appendix Transfusion guidelines in the study population

Hematocrit<35% and any of the following conditions:

Patient receiving⩾0.4 supplemental fractional inspired oxygen concentration by hood or continuous positive airway pressure or receiving fractional inspired oxygen concentration supplementation⩾0.35 on mechanical ventilation with mean airway pressure⩾9 or hypotension.

Hematocrit<28% and any of the following conditions:

Receiving⩾0.4 fractional inspired oxygen concentration by nasal cannula or⩾0.35 by mechanical ventilation;

Apnea or bradycardia⩾2 episodes in 24 h requiring bag and mask ventilation without any definite cause;

Heart rate⩾175 beats min−1 or respiratory rate⩾70 breaths min−1 for 24 h without any definite cause; and

Weight gain<10 g kg−1 day−1 for 4 days, while receiving⩾110 cal kg−1 day−1.

Hematocrit<20% asymptomatic with reticulocyte count<2%.

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Sharma, R., Kraemer, D., Torrazza, R. et al. Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants. J Perinatol 34, 858–862 (2014). https://doi.org/10.1038/jp.2014.59

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