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Am J Perinatol 2006; 23(8): 451-458
DOI: 10.1055/s-2006-951300
Copyright © by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Association of Necrotizing Enterocolitis with Elective Packed Red Blood Cell Transfusions in Stable, Growing, Premature Neonates

Pradeep Mally1 , 2 , Sergio G. Golombek2 , Ravi Mishra2 , Sarvesh Nigam2 , Kala Mohandas3 , Helene Depalhma3 , Edmund F. LaGamma2
  • 1Division of Neonatology, New York University School of Medicine, New York
  • 2The Regional Neonatal Center, Westchester Medical Center, New York Medical College, Valhalla, New York
  • 3Blood Bank, Westchester Medical Center-New York Medical College, Valhalla, New York
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Publication History

Publication Date:
28 September 2006 (online)

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ABSTRACT

The purpose of this study was to determine an association between packed red blood cell (PRBC) transfusions for anemia and necrotizing enterocolitis (NEC) in a subset of stable, growing, premature neonates. As part of a survey of current clinical practices over a 17-month period from June 1999 to October 2000, a chart review was performed to determine the relationship between elective PRBC transfusions and the occurrence of NEC. Demographic data were tabulated and compared between the NEC patients with a prior history of immediate blood transfusion (within 48 hours of onset of symptoms) and those NEC patients without a prior history of immediate blood transfusion. A total of 908 (inborn) neonatal admissions had received 751 PRBC transfusions during the study period; of these, 17 patients (1.8%) had developed radiographic, clinical, or surgical signs of NEC. Six cases of NEC (35%; six of 17 patients) were associated with PRBC transfusions (0.8%; six of 751 transfusions). The transfusion-associated NEC group developed presenting signs within 22 ± 5 hours (median, 19; range, 12 to 38) of a PRBC transfusion at a mean age of 32 ± 7 days. In contrast, the non-transfusion-associated NEC group (n = 11) had onset of NEC at a mean age of 12 ± 7 days (p < 0.05) after 185 ± 91 hours (median, 180; range, 96 to 312; p < 0.02] of a transfusion. Prior to the onset of NEC, all of the neonates in the transfusion-associated NEC group were stable, growing, not ventilated, receiving full enteral feedings, and had no other active medical problems except anemia (hematocrit, 24 ± 3%). In contrast, the nontransfusion NEC group was more often ventilated, was receiving < 50% of fluids by mouth, had lower Apgar scores, and was transfused for an average hematocrit of 37 ± 7% (p < 0.05). There was no significant difference in the type, storage, volume, or preservative used between the blood products in the two groups. We identified an unanticipated relationship between late-onset NEC in stable, growing, premature neonates who were transfused electively for anemia of prematurity.

KEYWORDS

Necrotizing enterocolitis - blood transfusion - preterm - anemia - oxygen delivery - oxygen consumption - sepsis - enteral feedings - apnea

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Pradeep MallyM.D. 

Division of Neonatology, New York University School of Medicine

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