Characteristics and incidence of transfusion-associated necrotizing enterocolitis in the UK

Abstract

Background and aims: The etiology of necrotizing enterocolitis (NEC) is unclear and postulated as being multifactorial. It has been suggested that one causative factor is the transfusion of packed red blood cells (PRBCs) leading to the disease entity commonly referred to as transfusion-associated NEC (TANEC). TANEC has been reported in North America but its incidence has not been formally investigated in the UK. Our aims were to identify the incidence of NEC and TANEC in tertiary-level UK neonatal units and to describe characteristics of TANEC cases.

Materials and methods: Using strict case definitions for NEC and TANEC, we undertook a retrospective review to estimate the incidence of TANEC cases occurring in four UK tertiary-level centers during a 38-month period.

Results: Of 8007 consecutive neonatal admissions of all gestations to the four centers, 68 babies went on to develop NEC and all affected infants were of very low birth weight (VLBW); 34 of these had previously received a transfusion of PRBCs but did not fit the diagnostic criteria for TANEC, whereas 15 (22%) of the 68 babies with NEC qualified as TANEC cases. UK cases occurred at an earlier postnatal age than cases reported in multiple large North American series and were of a lower birth weight.

Conclusions: We have confirmed the presence of TANEC in the UK VLBW neonatal population. Its incidence lies within the wide range described in previous reports of this phenomenon globally, though with some local variation in characteristics. Further work is needed to clarify causation, pathophysiology, and possible mechanisms of prevention of TANEC.

Keywords:

• Necrotizing
• blood transfusion
• very low birth weight
• premature

Acknowledgments and Dedication

We wish to sincerely thank all our colleagues in the hospital blood transfusion departments for greatly assisting in this study. PC also thanks Lisa Chalkley, previous Research Services Manager of the Norfolk and Norwich University Hospital NHS Foundation Trust, for kindly reviewing the project. The authors are most grateful to the anonymous journal reviewers for very helpful comments on an earlier version of this manuscript.

Dedication: We dedicate this work to the memory of Dr Shobha Cherian, consultant neonatologist and our respected friend, colleague, and co-author, who sadly died in November 2015.

Disclosure statement

PC and HVN are current Steering Group members of the Serious Hazards of Transfusion UK national haemovigilance scheme (SHOT). No potential conflict of interest was reported by the authors.