Journal of Neonatal-Perinatal Medicine 7 (2014) 193–198 DOI 10.3233/NPM-14814048 IOS Press
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Original Research
Association of packed red blood cell transfusion and necrotizing enterocolitis in very low birth weight infants K. AlFaleha,∗ , A. Al-Jebreena , A. Baqaysa , A. Al-Hallalia , K. Bedaiwia , N. Al-Balahia , A. AlGhamdia , T. AlKharfia and A. Alzahemb a Department
of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia b Department of Surgery (Division of Pediatric Surgery), College of Medicine, King Saud University, Riyadh, Saudi Arabia
Received 25 May 2014 Revised 27 August 2014 Accepted 13 August 2014
Abstract. OBJECTIVE: To investigate the association of PRBC transfusion and the development of NEC in VLBW preterm infants at a tertiary care neonatal unit. METHODS: A retrospective case-control study was performed. All VLBW infants (gestational age≤32 week and birth weight 0.05) in gestational age, birth weight, Apgar scores at 5th minute, maternal age, male gender, IUGR status, cesarean section, antenatal steroids, umbilical catheter usage, RDS, PDA, IVH, and BPD (Table 2). Most included infants in our cohort were formula fed. Infants who developed NEC and received PRBC transfusion within 48 hours prior to the development of symptoms had significantly higher rates of sepsis (p. value 0.004), and severe ROP (p. value 0.04). For our primary outcome, infants who received PRBC transfusion had a significantly lower incidence of severe NEC [OR 0.39 (95% CI 0.18, 0.84) p. value 0.02].
4. Discussion NEC is a major cause of morbidity and mortality in VLBW infants and considered a leading cause of short bowel syndrome in young infants [23, 24]. Despite its well-known multifactorial pathogenesis, multiple observational investigations have linked its occurrence with the preceding PRBC transfusions. Although small in size, our study showed a lower association of PRBC transfusions and the development of NEC in VLBW infants reviewed. Our data showed a strong association of severe NEC with sepsis and future development of severe ROP. The association of PRBC transfusion and the development of NEC was first described by MGardy and colleagues in 1987 following an outbreak of NEC in their unit [17]. Multiple case control and cohort observational studies supporting this association were
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K. AlFaleh et al. / NEC and PRBC transfusions
Fig. 1. Flow graph of study participants. Table 2 Demographic variables and secondary outcomes of the study subjects Variable GA [mean, (SD)] Birth weight [ mean, (SD)] Apgar 5 min [ mean, (SD)] Mother’s age [ mean, (SD)] Male gender SGA Cesarean section Antenatal steroids Umbilical catheter RDS PDA Sepsis IVH Severe ROP BPD
PRBC and NEC