Transfusion Related Necrotizing Enterocolitis in Very Low Birth Weight Infants Open Access
Patel, Ravi Mangal (2014)
Published
Abstract
Background: Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in very low birth weight (VLBW) infants. The risks of NEC associated with red blood cell (RBC) transfusion and severe anemia have not been prospectively characterized.
Methods: We performed a secondary analysis of a prospective, multicenter observational cohort study from Jan 2010 to Sept 2013 at 3 hospitals in Atlanta, Georgia to prospectively investigate the association between the exposure to RBC transfusion and severe anemia (hemoglobin ≤ 8g/dL) and the subsequent development of NEC in VLBW infants. We tested the primary hypothesis that the risk of NEC is greater in VLBW infants exposed to RBC transfusion compared to non-transfused VLBW infants. As a secondary aim, we evaluated if severe anemia was an independent risk factor for NEC. Multivariate Cox regression analyses were performed to evaluate the association between time-dependent covariates (RBC transfusion and severe anemia) and NEC (defined as Bell's Stage 2 or greater), after adjustment for birthweight and center.
Results: A total of 539 VLBW infants were evaluated and 40 (7.4%) infants developed NEC. Fifty-four percent (291/ 539) of enrolled VLBW infants received at least 1 RBC transfusion. After adjustment for birthweight, center, and severe anemia, the risk of NEC was higher for infants exposed to RBC transfusion in a given week, compared to non-transfused infants (hazard ratio (HR) 2.37; 95% confidence interval (CI) 1.06-5.30; P=0.036).Similarly, the risk of NEC was higher for infants with severe anemia in a given week compared to infants without severe anemia (HR 5.55; 95% CI 2.44-12.64; P<0.0001).
Conclusions: In this prospective study, RBC transfusion and severe anemia were both associated with an increased risk of NEC in VLBW infants. Further study is needed to determine if severe anemia is an important effect modifier of the risk of RBC transfusion.
Table of Contents
Introduction ………………………………………………………….……. Page 1
Background ………………………………………………………………… Pages 2 - 5
Methods ……………………………………………………………………… Pages 6 - 10
Results …………………………………………………………………….… Pages 11 - 14
Discussion ………………………………………………………………….. Pages 15 - 17
References …………………………………………………………………. Pages 18 - 22
Tables and Figures …………………………………………………….. Pages 23 - 35
Table 1. Baseline characteristics of RBC transfused and
non-transfused infants
Table 2. Baseline characteristics of infants with and without
NEC
Table 3. Clinical characteristics of RBC transfused and
non-transfused infants
Table 4. Clinical characteristics of infants with and without
NEC
Table 5. Univariable analysis of risk factors for NEC
Table 6. Multivariable analysis of risk factors for NEC
Table 7. Effect modification of the risk of RBC transfusion on NEC
by severe anemia
Table 8. Univariable analysis of risk factors for NEC among RBC
transfused patients
Table 9. Multivariable analysis of risk factors for NEC among RBC
transfused patients
Table 10. Sensitivity analysis of risk factors for NEC among RBC
transfused patients with post-hoc IST cut-point and removal of
center
Figure 1. Causal pathway depicting relationship between exposures
of interest, potential confounders and outcome.
Figure 2. Study flow diagram
Figure 3. Cumulative incidence of NEC and death for all enrolled
very low birth weight infants
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