Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Packed red blood cell transfusion is an independent risk factor for necrotizing enterocolitis in premature infants

Journal of Perinatology volume 33, pages 786–790 (2013)Cite this article

Subjects

Abstract

Objective:

To determine whether a temporal association exists between antecedent packed red blood cell (PRBC) transfusions and necrotizing enterocolitis (NEC) in premature infants.

Study Design:

This case–control study included inborn infants from a single center who developed NEC during a 2-year period. For every NEC infant, two matched controls from the same period were chosen based on gestational age and birth weight. Transfusion-related NEC was defined as antecedent PRBC transfusion within 48 h prior to the onset of any symptoms attributable to NEC. Bivariate analyses were used to compare baseline characteristics of all infants. To determine the raw odds ratio for the presence of exposure (transfusion) versus outcome (NEC), the hospital course (ages 6 to 63 days) of all study infants was divided into 48-h epochs; occurrence of transfusion and NEC was noted within each epoch. Generalized estimating equations were used to estimate the adjusted odds for developing NEC within an epoch with and without antecedent transfusion, controlling chronological age within infant as well as for gestational age, gender, feeding status in prior 48-h epoch and indicators of disease severity.

Result:

There were 3652 48-h epochs and 557 transfusions among 49 NEC infants and 97 controls; 17 infants had transfusion-related NEC, yielding a raw odds ratio of 3.01 (P<0.001). The adjusted odds ratios were 2.97 (P=0.003) for transfusion and 2.76 (P=0.05) for feeding status in the prior 48-h epoch. Infants who were being fed in the 48-h period prior to transfusion were more than eight times more likely to develop NEC than infants who were neither fed nor transfused.

Conclusion:

Antecedent PRBC transfusion appears to be an independent risk factor for developing NEC during the subsequent 48-h period.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Seges RA, Kenny A, Bird GW, Wingham J, Baals H, Stauffer UG . Pediatric surgical patients with severe anaerobic infection: report of 16 T-antigen positive cases and possible hazards of blood transfusion. J Pediatr Surg 1981; 16 (6): 905–910.

    Article  CAS  Google Scholar 

  2. Williams RA, Brown EF, Hurst D, Franklin LC . Transfusion of infants with activation of erythrocyte T antigen. J Pediatr 1989; 115 (6): 949–953.

    Article  CAS  Google Scholar 

  3. Marshall LR, Barr AL, French NP, Lown JA, Knowles S . A fatal case of necrotizing enterocolitis in a neonate with polyagglutination of red blood cells. J Pediatr Child Health 1993; 29 (1): 63–65.

    Article  CAS  Google Scholar 

  4. Mupanemunda RH, Kenyon CF, Inwood MJ, Leigh K . Bacterial-induced activation of erythrocyte T-antigen complicating necrotising enterocolitis: a case report. Eur J Pediatr 1993; 152 (4): 325–326.

    Article  CAS  Google Scholar 

  5. McGrady GA, Rettig PJ, Istre GR, Jason JM, Holman RC, Evatt BL . An outbreak of necrotizing enterocolitis. Association with transfusions of packed red blood cells. Am J Epidemiol 1987; 126 (6): 1165–1172.

    Article  CAS  Google Scholar 

  6. Agwu JC, Narchi H . In a preterm infant, does blood transfusion increase the risk of necrotizing enterocolitis? Arch Dis Child 2005; 90: 102–103.

    Article  CAS  Google Scholar 

  7. Short A, Gallagher A, Ahmed M . Necrotising enterocolitis following blood transfusion. Arch Dis Child 2005; 90: 102–103.

    Article  Google Scholar 

  8. Christensen RD, Wiedmeier SE, Baer VL, Henry E, Gerday E, Lambert DK et al. Antecedents of Bell stage III necrotizing enterocolitis. J Perinatol 2010; 30: 54–57.

    Article  CAS  Google Scholar 

  9. Bell JM, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L et al. Neonatal necrotizing enterocolitis: therapeutic decision based upon clinical staging. Ann Surg 1978; 187: 1–7.

    Article  CAS  Google Scholar 

  10. Walsh MC, Kliegman RM . Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33: 179–201.

    Article  CAS  Google Scholar 

  11. Josephson CD, Wesolowski A, Bao G, Sola-Visner MC, Dudell G, Castillejo MI et al. Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants? J Pediatr 2010; 157 (6): 972–978.

    Article  Google Scholar 

  12. Singh R, Visintainer PF, Frantz ID III, Shah BL, Meyer KM, Favila SA et al. Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants. J Perinatol 2011; 31: 176–182.

    Article  CAS  Google Scholar 

  13. Christensen RD, Lambert DK, Henry E, Wiedmeier SE, Snow GL, Baer VL et al. Is “transfusion-associated necrotizing enterocolitis” an authentic pathogenic entity? Transfusion 2010; 50 (5): 1106–1112.

    Article  Google Scholar 

  14. Mally P, Golombek SG, Mishra R, Nigam S, Mohandas K, Depalhma H et al. Association of necrotizing enterocolitis with elective packed red blood cell transfusions in stable, growing, premature neonates. Am J Perinatol 2006; 23: 451–458.

    Article  Google Scholar 

  15. Blau J, Calo JM, Dozor D, Sutton M, Alpan G, La Gamma EF . Transfusion-related acute gut injury: necrotizing enterocolitis in very low birth weight neonates after packed red blood cell transfusion. J Pediatr 2011; 58 (3): 403–409.

    Article  Google Scholar 

  16. El Dib M, Narang S, Lee E, Massaro AN, Aly H . Red blood cell transfusion, feeding and necrotizing enterocolitis in preterm infants. J Perinatol 2011; 31: 183–187.

    Article  CAS  Google Scholar 

  17. D’Agostino RB Jr. . Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998; 17: 2265–2281.

    Article  Google Scholar 

  18. Hendrickson JE, Hillyer CD . Noninfectious serious hazards of transfusion. Anesth Analg 2009; 108 (3): 759–769.

    Article  Google Scholar 

  19. Paul DA, Mackley A, Novitsky A, Zhao Y, Brooks A, Locke RG . Increased odds of necrotizing enterocolitis after transfusion of red blood cells in premature infants. Pediatrics 2011; 127 (4): 635–641.

    Article  Google Scholar 

  20. Gretchen AK, Baker R, Yanowitz TB . Blood transfusion alters the superior mesenteric artery blood flow velocity response to feeding in premature infants. Am J Perinatol 2009; 26 (2): 99–105.

    Article  Google Scholar 

  21. Nelle M, Hocker C, Zilow EP, Linderkamp O Effects of red cell transfusion on cardiac output and blood flow velocites in cerebral and gastrointestinal arteries in premature infants.

  22. Jawa RS, Anillo S, Kulaylat MN . Transfusion-related acute lung injury. J Int Care Med 2008; 23 (2): 109–121.

    Article  Google Scholar 

  23. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T et al. Duration of red cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229–1239.

    Article  CAS  Google Scholar 

  24. Sibbons P, Spitz L, Velzen DV . The use of animal models in the study of necrotizing enterocolitis in the newborn. Semin Neonatol 1997; 2: 281–290.

    Article  Google Scholar 

  25. Fergusson D, Herbert P, Hogan DL, LeBel L, Rouvinez-Bouali N, Smyth JA et al. Effect of fresh red bllod cells transfusions on clinical outcomes in premature, very low-birth-weight infants. JAMA 2012; 308 (14): 1443–1451.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Winthrop University Hospital, Mineola, NY, USA

    P Wan-Huen

  2. Department of Pediatrics, Morgan Stanley Children’s Hospital of New York, Columbia University, Mineola, NY, USA

    D Bateman & E Parravicini

  3. Department of Biological Sciences, Long Island University, Brooklyn, NY, USA

    D M Shapiro

Authors
  1. P Wan-Huen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Bateman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D M Shapiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E Parravicini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Wan-Huen.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

AUTHOR CONTRIBUTIONS

The first draft was written by Phyllis Wan-Huen. Each author listed on the manuscript has participated in the concept, design, analysis and interpretation of data, drafting or revising of the manuscript, and has seen and approved the submission of this version of the manuscript, and takes full responsibility for its contents.

DISCLAIMER

No external funding was used to support the collection of data, the analysis or the preparation of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wan-Huen, P., Bateman, D., Shapiro, D. et al. Packed red blood cell transfusion is an independent risk factor for necrotizing enterocolitis in premature infants. J Perinatol 33, 786–790 (2013). https://doi.org/10.1038/jp.2013.60

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.60

Keywords

This article is cited by

Search

Advanced search

Quick links