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Arch Dis Child Fetal Neonatal Ed 98:F10-F14 doi:10.1136/fetalneonatal-2011-301282
  • Original articles

Transfusion-associated necrotising enterocolitis in neonates

  1. Prakesh S Shah4
  1. 1Department of Cardiology, Women's and Children's Hospital of British Columbia, Vancouver, Canada
  2. 2Department of Neonatology, Women's and Children's Hospital of British Columbia, Vancouver, Canada
  3. 3Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
  4. 4Department of Paediatrics and HPME, University of Toronto, Mount Sinai Hospital, Toronto, Canada
  1. Correspondence to Amelie Isabell Stritzke, Women's and Children's Hospital of British Columbia, Cardiology, 4490 Oak Street, Vancouver, BC V6H 3V4, Canada; astritzke{at}cw.bc.ca
  1. Contributors Amelie Stritzke, initiated the concept, assembled the cohort, interpreted the data, wrote the first draft and revisions of the manuscript, and approved the final version. John Smyth, initiated the concept, revised the protocol, assisted with the data interpretation and approved the final version of the manuscript. Anne R Synnes, initiated the concept, revised the protocol, assisted with the data interpretation and approved the final version of the manuscript. Shoo K Lee, participated in the design, revised the protocol, assisted with the data interpretation and approved the final version of the manuscript. Prakesh S Shah, contributed to the concept and design, revised the protocol, interpreted data, revised the manuscript and approved the final version of the manuscript. Site Investigators of the Canadian Neonatal Network includes: Shoo K. Lee, (Director, Canadian Neonatal Network); Prakesh S. Shah (Associate Director, Canadian Neonatal Network and site investigator Mount Sinai Hospital, Toronto); Wayne Andrews (Janeway Children's Health and Rehabilitation Centre, St John's, NL); Keith Barrington (Sainte Justine Hospital, Montreal, QC); Wendy Yee (Foothills Medical Centre, Calgary, AB); Barbara Bullied (Everett Chalmers Hospital, Fredericton, NB); Roderick Canning (Moncton Hospital, Moncton, NB); Ruben Alvaro (St. Boniface General Hospital, Winnipeg, MB); Kimberly Dow (Kingston General Hospital, Kingston, ON); Michael Dunn (Sunnybrook Health Sciences Centre, Toronto, ON); Adele Harrison (Victoria General Hospital, Victoria, BC); Andrew James (The Hospital for Sick Children, Toronto, ON); Zarin Kalapesi (Regina General Hospital, Regina, SK); Lajos Kovacs (Jewish General Hospital, Montreal, QC); Orlando da Silva (St. Joseph's Health Centre; London, ON); Douglas D. McMillan (IWK Health Centre, Halifax, NS); Cecil Ojah (St. John Regional Hospital, St. John, NB); Abraham Peliowski/Khalid Aziz (Royal Alexandra Hospital, Edmonton, AB); Bruno Piedboeuf (Centre hospitalier universitaire de Québec, Sainte Foy, QC); Patricia Riley (Montreal Children's Hospital, Montreal, QC); Daniel Faucher (Royal Victoria Hospital, Montreal, QC); Nicole Rouvinez-Bouali (Children's Hospital of Eastern Ontario, Ottawa, ON); Koravangattu Sankaran (Royal University Hospital, Saskatoon, SK); Mary Seshia (Health Sciences Centre, Winnipeg, MB); Sandesh Shivananda (Hamilton Health Sciences Centre, Hamilton, ON); Zenon Cieslak (Royal Columbian Hospital, New Westminster, BC); Anne Synnes (BC Women's Hospital and Health Centre, Vancouver, BC); Herve Walti (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, QC).

  • Received 27 October 2011
  • Accepted 19 February 2012
  • Published Online First 23 March 2012

Abstract

Objective To evaluate the association between blood transfusion in previous 2 days and necrotising enterocolitis (NEC) in infants admitted to neonatal intensive care units in Canada.

Patients and Methods Using the Canadian Neonatal Network database of admissions to neonatal intensive care units from 2003 to 2008, cases with NEC were matched with controls by gestational age (GA) at birth. Exposure to transfusion within 2 days of NEC (for cases) or 2 days before the median age of NEC diagnosis among cases of the same GA (for controls) was determined. After controlling for confounders, the differences in characteristics and neonatal outcomes of transfusion-associated NEC (TANEC) and NEC not associated with transfusion (non-TANEC) were compared.

Results NEC cases (n=927) were matched with 2781 controls. Transfusion in previous 2 days was significantly higher in NEC cases than in controls (15.5 vs 7.7%; adjusted OR (AOR) 2. 44; 95% CI 1.87 to 3.18). TANEC cases versus non-TANEC cases had a lower mean GA (25.8 vs 29.3 weeks), a lower mean birthweight (885 vs 1373 grams), and a higher proportion of infants with SNAPII score >20 (52.1 vs 22.9%). After adjustment for confounders, no significant differences in mortality (AOR 1.28, 95% CI 0.82 to 2.01), severe retinopathy (AOR 1.15, 95% CI 0.71 to 1.87), or severe neurological injury (AOR 0.83, 95% CI 0.43 to 1.60) were identified.

Conclusions Exposure to transfusion in previous 2 days was an independent risk factor for NEC. After controlling for confounders, no significant differences in mortality and morbidities were observed between infants who had transfusion-associated NEC and those with NEC not associated with transfusion.

Footnotes

  • Competing interests None.

  • Ethics approval Local Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Not available.

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