Transfusion-associated necrotizing enterocolitis (NEC) in extremely preterm infants: experience of a tertiary neonatal center in UK

Abstract

Objective

To compare the characteristics and short-term outcomes in extremely preterm infants, who developed necrotizing enterocolitis (NEC) following a packed red blood cell transfusion (pRBC) within 48 h (TANEC), with those who developed NEC beyond 48 h (non-TANEC).

Setting

A single-center retrospective cohort study in a Tertiary neonatal intensive care unit in the UK over a 5-year period

Patients and methods

Extremely premature infants (23–27 weeks gestation) were selected. TANEC and non-TANEC incidence were calculated from the confirmed NEC group (defined as modified Bell’s stage II and beyond). The characteristics and short-term outcomes of infants with TANEC in the first 8 weeks of life were compared to infants with non-TANEC.

Results and interpretation

Incidence of confirmed NEC was 14% (28/207). On further subgroup analysis of the confirmed NEC cases, 46% (13/28) of infants were identified with TANEC and 54% (15/28) with non-TANEC. The incidence of TANEC did not correlate with the number of antecedent pRBC transfusions or the pre-transfusion median hemoglobin (Hb) levels. There were no significant differences in characteristics between the TANEC and non-TANEC groups. Infants within the TANEC group required more intensive neonatal care support, greater surgical intervention (p-value 0.043) with loss of gut integrity and an increase in number of TPN dependency days (p-value 0.014).

Conclusions

A significantly worse clinical course and short-term outcome was observed in the TANEC group when compared with the non-TANEC group.

Keywords:

• Neonatology
• gastroenterology
• NEC
• transfusion
• anemia

Acknowledgements

The authors would like to acknowledge Dr Gareth Penman and Dr Anupam Gupta, Consultant Neonatologists, St Mary’s Hospital, Manchester (United Kingdom) for their suggestions during the final revsion of this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).