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Development of necrotizing enterocolitis after blood transfusion in very premature neonates

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Abstract

Background

Prior studies report conflicting evidence on the association between packed red blood cell (PRBC) transfusions and necrotizing enterocolitis (NEC), especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC. The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life (DOL) 14 in very premature neonates.

Methods

A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14. Primary endpoints were PRBC transfusions after DOL 14 until the date of NEC diagnosis, discharge, or death. Wilcoxon ranked-sum and Fisher’s exact tests, Cox proportional hazards regression, and Kaplan–Meier curves were used to analyze data.

Results

Of 549 premature neonates, 186 (34%) received transfusions after DOL 14 and nine (2%) developed NEC (median DOL = 38; interquartile range = 32–46). Of the nine with NEC after DOL 14, all were previously transfused (P < 0.001); therefore, hazard of NEC could not be estimated. Post hoc analysis of patients from DOL 10 onward included five additional patients who developed NEC between DOL 10 and DOL 14, and the hazard of NEC increased by a factor of nearly six after PRBC transfusion (hazard ratio = 5.76, 95% confidence interval = 1.02–32.7; P = 0.048).

Conclusions

Transfusions were strongly associated with NEC after DOL 14. Prospective studies are needed to determine if restrictive transfusion practices can decrease incidence of NEC after DOL 14.

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Data availability

Identified study data cannot be provided due to the need to protect patient confidentiality. Deidentified data may be provided by the authors upon request.

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Acknowledgements

We thank Sherry Moseley, RN for assistance with data acquisition for this study. We thank the James and Connie Maynard Children's Hospital at ECU Health Medical Center for sharing data used in this study.

Funding

There was no financial or materials support for this study.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Texas Health Sciences Campus, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA

    Travis L. Odom

  2. Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA

    Travis L. Odom, Jessica Eubanks, Nusiebeh Redpath, Erica Davenport, Dmitry Tumin & Uduak S. Akpan

  3. ECU Health Medical Center, Greenville, NC, USA

    Travis L. Odom, Jessica Eubanks, Nusiebeh Redpath & Erica Davenport

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Contributions

OT participated in study conception and design, data acquisition, interpretation of results, and drafting of the manuscript. EJ, RN and DE participated in data acquisition, interpretation of results, and drafting of the manuscript. TD participated in study conception and design, statistical analysis, interpretation of results, and drafting of the manuscript. AU participated in study conception and design, data acquisition, interpretation of results, and critical revision of the manuscript and supervised the study. All authors reviewed the final version of the manuscript and approved its submission for publication.

Corresponding author

Correspondence to Travis L. Odom.

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Ethical approval

The study protocol was reviewed and approved by the ECU University and Medical Center Institutional Review Board with a waiver of consent (approval number: UMCIRB 20–000643). No identifying information was included in this retrospective study. This research was conducted in accordance with the ethical standards of all applicable national and institutional committees and the World Medical Association’s Helsinki Declaration.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. The authors have no conflict of interest to declare.

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Odom, T.L., Eubanks, J., Redpath, N. et al. Development of necrotizing enterocolitis after blood transfusion in very premature neonates. World J Pediatr 19, 68–75 (2023). https://doi.org/10.1007/s12519-022-00627-0

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  • DOI: https://doi.org/10.1007/s12519-022-00627-0

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