Increased Odds of Necrotizing Enterocolitis After Transfusion of Red Blood Cells in Premature Infants

Paul, David A.; Mackley, Amy; Novitsky, Alexandra; Zhao, Yong; Brooks, Alison; Locke, Robert

doi:10.1542/peds.2010-3178

Cited by 157 publications

(114 citation statements)

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“…The association between RBC transfusion and the subsequent development of NEC is well documented. [20][21][22][23][24][25][26][27][28] Our current findings suggest that investigating eosinophils as participants in the pathogenesis of transfusionassociated NEC might be fruitful. We realize several weaknesses in our study, largely derivative of the retrospective methodology.…”

Section: Discussionmentioning

confidence: 64%

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

et al. 2011

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Objective: We hypothesized that neonates with bloody stools and concomitant eosinophilia are likely to have atopic enteropathy rather than necrotizing enterocolitis (NEC).Study Design: This was a retrospective cross-sectional study using electronic medical records and paper charts. Records of neonates admitted to any Intermountain Healthcare NICU between 1 January 2005 and 30 June 2010 were eligible if 'bloody stools' were listed in any archive. Qualifying records were divided into two groups depending on whether or not within 72 h of passing bloody stool eosinophil counts were above the 95th percentile reference range limit for age.Result: Bloody stools were identified in 275 predominantly Caucasian neonates. Fifty-four of these had eosinophilia and 221 had normal eosinophil counts. Those with eosinophilia were born at a slightly younger gestational age (31.3±4.6 vs 32.6±4.0 weeks, mean±s.d., P ¼ 0.032). Contrary to our hypothesis, those with eosinophilia did not have a lower rate of pneumatosis or bowel resection, or death ascribed to NEC. Eosinophilia was more common among those who had a red blood cell (RBC) transfusion within 48 h before passing bloody stools (P<0.001). Those with a recent RBC transfusion were the only neonates to have NEC surgery or to die from NEC. Preceding the bloody stools, those with no antecedent transfusion had been fed a larger volume (P ¼ 0.014), and had trends toward receiving calorically enriched feedings (P ¼ 0.055) and recent addition of human milk fortifier (P ¼ 0.060). Eosinophil counts following RBC transfusion tended to increase for 3-6 days, but when bloody stools were not preceded by transfusion the eosinophil counts were more static over that period. Conclusion:In this predominantly Caucasian group of neonates with bloody stools, the presence of eosinophilia did not identify a benign condition distinct from NEC. A total of 44% of these neonates had transfusion-associated NEC. Eosinophils could have a previously unrecognized role in the pathogenesis of this NEC subtype. Keywords: necrotizing enterocolitis; bloody stools; eosinophilia; RBC transfusion; transfusion-associated NEC; atopic enteropathy Introduction Eosinophilia is diagnosed when the concentration of eosinophils in the blood exceeds the upper reference range limit. 1 Until recently, this upper limit was not well defined for neonates, allowing imprecision in defining eosinophilia and in identifying associations between it and various clinical conditions. Using laboratory values from over 63 000 neonates we recently reported the 5th and 95th percentile values for blood eosinophil concentrations at various gestational and postnatal ages. 2 The 95th percentile upper limit ranges from 1180 eosinophils ml À1 in the first week to about 1560 ml À1 after 3 weeks. 2 Given this more precise definition of neonatal eosinophilia, we commenced the present study of the association between bloody stools and eosinophilia.When bloody stools are observed in a neonate, the possibility of necrotizing enterocolitis (NEC) enters the ...

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Section: Discussionmentioning

confidence: 64%

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

et al. 2011

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“…171 ➢ Blood transfusion. Transfusion of red blood cells has long been suspected to contribute to the occurrence or severity of NEC, [150][151][152][153][154][155]172 One proposed mechanism is that a sudden increase in blood viscosity would reduce mesenteric blood flow and, in case of simultaneous enteral feeding, cause a relative ischemia. 30 An alternative explanation is an immunologic influence working through mesenteric arterial reactivity and nitric oxide pathways as investigated in premature lambs.…”

Section: Pathophysiologymentioning

confidence: 99%

Necrotising Enterocolitis - epidemiology and imaging

Ahle¹

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“…Transfusion associated NEC (TANEC) has been reported in multiple studies, although the causality between PRBC transfusion and NEC has not yet been established [27][28][29]. Majority of very low birth weight (VLBW) infants require one or more PRBC transfusions during their stay in the neonatal intensive care unit (NICU [30], thus making TANEC, an important entity to consider.…”

Section: Nec Sipmentioning

confidence: 99%

Necrotizing Enterocolitis (NEC): A Devastating Disease of Prematurity

Garg¹,

Garg²,

Lal³

2015

J Neonatal Biol

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Necrotizing Enterocolitis (NEC) is a common and devastating gastrointestinal emergency that primarily affects premature infants. The incidence of necrotizing enterocolitis is 6-10% among infants with birth weight less than 1500 grams. The mortality due to NEC has not improved significantly despite advances in neonatal care and better understanding of clinical and basic sciences. The pathogenesis of NEC is not well understood and several factors such as prematurity, abnormal colonization with pathogenic bacteria, feeding practices, blood transfusion and altered intestinal barrier function may be involved. The clinical presentation of NEC could be sudden and the treatment plan could vary with the stage and type of presentation. Further research is needed to better understand the pathophysiology of NEC and, biomarkers for prediction, prevention and treatment need to be developed. Further clinical trials are needed to determine prevention and treatment modalities for this devastating disease.

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Increased Odds of Necrotizing Enterocolitis After Transfusion of Red Blood Cells in Premature Infants

Abstract: In our study sample, PRBC transfusion was associated with increased odds of NEC. The rate of NEC after transfusion was 1.4%. From our data we could not determine if PRBC transfusions were part of the causal pathway for NEC or were indicative of other factors that may be causal for NEC.

Cited by 157 publications

References 20 publications

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

Necrotising Enterocolitis - epidemiology and imaging

Necrotizing Enterocolitis (NEC): A Devastating Disease of Prematurity

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