2014, Number 4
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An Med Asoc Med Hosp ABC 2014; 59 (4)
Transfusion of packed red blood cells associated with necrotizing enterocolitis in preterm neonates
Orozco RDP, Zamorano JCA, Iglesias LJ, Bernárdez-Zapata I
Language: Spanish
References: 28
Page: 261-266
PDF size: 204.55 Kb.
ABSTRACT
Introduction: Preterm neonates, in particular those with very low birth weight, are prone to get multiple transfusions during their hospital stay at neonatal special care units. The primary objective was to determine risk factors for necrotizing enterocolitis, with emphasis on packed red blood cell transfusions.
Material and methods: Observational, longitudinal, retrospective cohort study. We included 210 newborns (n = 120) weighing less than 2 kg upon entry.
Results: We analyzed 210 neonates with average weight of 1,510.9 ± 346 g, and median gestational age of 32.2 ± 2.5 weeks. Thirty nine neonates were diagnosed with necrotizing enterocolitis stage 2 and advanced stages with an average weight of 1,353.5 ± 365.3 g and median gestational age of 31.1 ± 2.4 weeks, p = 0.004. The risk factors associated with the development of necrotizing enterocolitis were weight equal or less than 1,500 g at birth, OR 2.3 IC 95% (4.7), p = 0.022; gestational age equal or less than 34 weeks, OR 5.7, IC 95% (1.7-19.6), p = 0.005; and our analysis showed that packed red blood cell transfusions, OR 5.3, IC 95% (2.4-11.7), p = 0.0001.
Discussion and conclusions: Necrotizing enterocolitis is still a multifactorial entity, and according to the results from this study, packed red blood cell transfusions are an important risk factor associated with it.
REFERENCES
Sankaran K, Puckett B, Lee DS, Seshia M, Boulton J, Qiu Z et al. Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units. J Pediatr Gastroenterol Nutr. 2004; 39 (4): 366-372.
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.
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 (3): 183-187.
Perciaccante JV, Young TE. Necrotizing enterocolitis associated with packed red blood cell transfusions in premature neonates. E-Pas. 2008; 2839.8.
Mally P, Golombek SG, Mishra R, Nigam S, Mohandas K, Depalhma H et al. Association of necrotizing enterocolitis with elective red blood cell transfusions in stable, growing, premature neonates. Am J Perinatol. 2006; 23 (8): 451-458.
Simmonds A, LaGamma EF. Adressing the “new” NEC: Part I: rediscovering the basics. Indian J Pediatr. 2006; 73 (11): 1011-1018.
Fasano R, Luban NL. Blood component therapy. Pediatr Clin N Am. 2008; 55 (2): 421-445.
Wang-Rodríguez J, Fry E, Fiebig E, Lee T, Busch M, Mannino F et al. Immune response to blood transfusion in very-low birthweight infants. Transfusion. 2000; 40: 25-34.
Reynolds JD, Ahearn GS, Angelo M, Zhang J, Cobb F, Stamler JS. S-nitrosohemoglobin deficiency: a mechanism for loss of physiological activity in banked blood. PNAS. 2007; 104 (43): 17058-17062.
Sanders M, Allen M, Alexander GR, Yankowitz J, Graeber J, Johnson TR et al. Gestational age assessment in preterm neonates weighing less than 1,500 grams. Pediatrics. 1991; 88 (3): 542-546.
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978; 187 (1): 1-7.
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: 1106-1112.
Parker LA, Neu J, Torrazza RM, Li Y. Scientifically based strategies for enteral feeding in premature infants. Neoreviews. 2013; 14 (7): 350-359.
David AP, Mackley A, Novitsky A, Zhao Y, Brooks A, Locke RG. Increase of necrotizing enterocolitis after transfusion of red blood cells in premature infants. Pediatrics. 2011; 127: 635.
Valieva OA, Strandjord TP, Mayock DE, Juul SE. Effects of transfusions in extremely low birth weight infants: a restrospective study. J Pediatr. 2009; 155 (3): 331-337.
Stritzke AI, Smyth J, Synnes A, Lee SK, Shah PS. Transfusion-associated necrotising enterocolitis in neonates. Arch Dis Child Fetal Neonatal. 2013; 98: F10-14.
Verhoeff FH, Milligan P, Brabin BJ, Mlanga S, Nakoma V. Gestational age assessment by nurses in a developing country using the Ballard method, external criteria only. Ann Trop Paediatr. 1997; 17 (4): 333-342.
Wapner R, Jobe AH. Controversy: antenatal steroids. Clin perinatol. 2011; 38 (3): 529-545.
Nasef N, Shabaan AE, Schurr P, Iaboni D, Choudhury J, Church P et al. Effect of clinical and histological chorioamnionitis on the outcome of preterm infants. Am J Perinatol. 2013; 30 (1): 59-68.
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; 158 (3): 403-409.
Wan-Huen P, Baterman D, Shapiro DM, Parravicini E. Packed red blood cell transfusion is an independent risk factor of necrotizing enterocolitis in premature infants. Journal of Perinatology. 2013; 33: 786-790.
Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009; 113: 3406-3417.
Krimmel GA, Baker R, Yanowitz TD. Blood transfusion alters the superior mesenteric artery blood flow velocity response to feeding in premature infants. Am J Perinatol. 2009; 26: 99-106.
Lucas A, Cole TJ. Breast milk and neonatal necrotizing enterocolitis. Lancet. 1990; 336 (8730): 1519-1523.
Singh T, Visintainer PF, Frantz ID, 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 (3): 176-182.
Sellmer A, Bjerre JV, Schmidt MR, McNamara PJ, Hjortdal VE, Host B et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch Dis Child Fetal Neonatal. 2013; 98 (6): F505-510
Josephson CD, Wesolowski A, Bao G, Sola-Visner MC, Dudell G, Castillejo MI. Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants? J Pediatr. 2010; 157: 972-978.
Christensen RD, Ilstrup S. Recent advances toward defining the benefits and risks of erythrocyte transfusions in neonates. Arch Dis Child Fetal Neonatal. 2013; 98: F365-F372.