Transfusion Associated Necrotizing Enterocolitis: A Meta-analysis of Observational Data

Mohamed, Adel; Shah, Parkesh S.

doi:10.1542/peds.2011-2872

Cited by 257 publications

(218 citation statements)

References 25 publications

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“…In a meta-analysis of 11 retrospective case-control studies and one cohort study, Mohamed and Shah reported the association between blood transfusion and NEC. 76 The total number of transfusionassociated NEC cases in the meta-analysis was 365. The OR of NEC being present after a recent blood transfusion was 2.01, indicating a significant association.…”

Section: Blood Transfusionmentioning

confidence: 99%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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Necrotizing enterocolitis is the most common gastrointestinal emergency in neonates, particularly in those born very preterm. It is a leading cause of morbidity and mortality, especially in extremely low birth weight infants. Despite extensive research, the pathophysiology of necrotizing enterocolitis remains unclear and therapeutic options are limited. Multiple risk factors have been reported, but most are associated with prematurity and its complications. This makes management very challenging in vulnerable preterm infants. In this review, we focus on the risk factors and some of the current research in this area, particularly studies aimed at early detection and potential preventive measures for this potentially lethal condition.

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Section: Blood Transfusionmentioning

confidence: 99%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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“…It may be argued that a restrictive transfusion practice is preferable, as more very preterm infants avoid transfusion without a worse outcome [26]. An alternate interpretation may be that a liberal transfusion practice is better for the possibility of a post hoc advantage in cognition [23].…”

Section: Current Rct-based Recommendationsmentioning

confidence: 99%

“…Several uniquely neonatal adverse associations have been demonstrated in epidemiological studies [29]. These include death [30], necrotising enterocolitis (NEC) [26,31], intraventricular haemorrhage (IVH) [32,33], retinopathy of prematurity (ROP) [34] and chronic lung disease (CLD) [35]. It is important to note however, that these observational studies using case control or retrospective cohort methodology report risk ratios for NEC following exposure to RBC transfusion that far exceed those demonstrated in randomised trials.…”

Section: Transfusion Safetymentioning

confidence: 99%

Anaemia in the Premature Infant and Red Blood Cell Transfusion: New Approaches to an Age-Old Problem

Andersen

Keir

Kirpalani

et al. 2015

Curr Treat Options Peds

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Opinion statementRed blood cell (RBC) transfusion is a common intervention in very preterm infants with variable utilisation between centres and individual clinicians. This variation likely reflects uncertainty about who, when and how much to transfuse. Most RBC transfusions are given in small volumes as "top-up" for anaemia or cumulative phlebotomy loss. Whilst the newly born infant may have a low haemoglobin (Hb) value, it is uncertain if this is of clinical or physiologic significance except at extreme values. Little attention has been given to the potentially favourable effect of RBC transfusion on oxygen kinetics, particularly in the interval after birth when the risk of hypoxic ischaemia is high. Later anaemia, at the time of likely Hb nadir, more typifies anaemia of prematurity. In this article, we will firstly review the conventional model of RBC transfusion based on haemoglobin [Hb] thresholds and secondly, we will propose an alternate, individualised, practice based on the oxygen physiology. This effectively reframes the potential role of RBC transfusion in the very preterm infant and demands a new generation of clinical trials.

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“…21 In addition, with new evidence from recent studies that demonstrate potential side effects of red cell transfusions, such as extension of ICH and transfusionassociated NEC, [11][12][13]22 the need to study the safety and efficacy of ESAs, in combination with restrictive transfusion guidelines, urgently increases. This is the first prospective, randomized, masked, multicenter study of early Darbe administered to preterm infants, and the first study of ESA administration to preterm infants that resulted in a significant decrease in both donor exposure and transfusion number.…”

Section: Figurementioning

confidence: 99%

“…In both analyses the importance of 1 or 2 fewer transfusions was questioned. 27,28 However, this benefit might have greater clinical significance in light of recent associations between early transfusions and severe ICH, 12 late transfusions and the development of NEC, 11,22 and potentially damaging concentrations of heavy metals, such as lead and mercury. 29 It is possible that even 1 to 2 fewer transfusions at key periods during a NICU course could be beneficial.…”

Section: Figurementioning

confidence: 99%

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

Ohls¹,

Christensen

Kamath‐Rayne

et al. 2013

Pediatrics

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BACKGROUND: A novel erythropoiesis stimulating agent (ESA), darbepoetin alfa (Darbe), increases hematocrit in anemic adults when administered every 1 to 3 weeks. Weekly Darbe dosing has not been evaluated in preterm infants. We hypothesized that infants would respond to Darbe by decreasing transfusion needs compared with placebo, with less-frequent dosing than erythropoietin (Epo). METHODS: Preterm infants 500 to 1250 g birth weight and ≤48 hours of age were randomized to Darbe (10 μg/kg, 1 time per week subcutaneously), Epo (400 U/kg, 3 times per week subcutaneously) or placebo (sham dosing) through 35 weeks’ gestation. All received supplemental iron, folate, and vitamin E, and were transfused according to protocol. Transfusions (primary outcome), complete blood counts, absolute reticulocyte counts (ARCs), phlebotomy losses, and adverse events were recorded. RESULTS: A total of 102 infants (946 ± 196 g, 27.7 ± 1.8 weeks’ gestation, 51 ± 25 hours of age at first dose) were enrolled. Infants in the Darbe and Epo groups received significantly fewer transfusions (P = .015) and were exposed to fewer donors (P = .044) than the placebo group (Darbe: 1.2 ± 2.4 transfusions and 0.7 ± 1.2 donors per infant; Epo: 1.2 ± 1.6 transfusions and 0.8 ± 1.0 donors per infant; placebo: 2.4 ± 2.9 transfusions and 1.2 ± 1.3 donors per infant). Hematocrit and ARC were higher in the Darbe and Epo groups compared with placebo (P = .001, Darbe and Epo versus placebo for both hematocrit and ARCs). Morbidities were similar among groups, including the incidence of retinopathy of prematurity. CONCLUSIONS: Infants receiving Darbe or Epo received fewer transfusions and fewer donor exposures, and fewer injections were given to Darbe recipients. Darbepoetin and Epo successfully serve as adjuncts to transfusions in maintaining red cell mass in preterm infants.

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Transfusion Associated Necrotizing Enterocolitis: A Meta-analysis of Observational Data

Abstract: Recent exposure to transfusion was associated with NEC in neonates. Neonates who developed TANEC were at overall higher risk of NEC. TANEC patients were at higher risk of mortality, but additional studies adjusting for confounders are needed.

Cited by 257 publications

References 25 publications

Necrotizing enterocolitis: current perspectives

Necrotizing enterocolitis: current perspectives

Anaemia in the Premature Infant and Red Blood Cell Transfusion: New Approaches to an Age-Old Problem

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

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