The Association of Severe Anemia, Red Blood Cell Transfusion and Necrotizing Enterocolitis in Neonates

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Jul 20

PMID 34283868

Citations 11

Authors

Juan Song

Huimin Dong

Falin Xu

Yong Wang

Wendong Li

Zhenzhen Jue

Lele Wei

Yuyang Yue

Changlian Zhu

Affiliations

Soon will be listed here.

Abstract

Background: The relationship between severe anemia, red blood cell transfusion and Neonatal necrotizing enterocolitis (NEC) remains controversial. The purpose of this study was to determine the association of severe anemia and RBC transfusion with NEC in neonates.

Methods: The clinical characteristics of NEC were observed in 467 infants with different birth weights from January 2012 to July 2020. A 1:1 ratio case-control study was performed in very low birth weight (VLBW) infants. Severe anemia, RBC transfusion, and confounding factors, including maternal and perinatal complications, feeding, and antibiotics administration were collected in both groups. Univariate and multivariate analyses were used to investigate effects on the risk of NEC.

Results: The day of NEC onset and mortality were inversely associated with birth weight. In VLBW infants, adjusting for other factors, severe anemia within 72 h [OR = 2.404, P = 0.016], RBC transfusion within 24 h [OR = 4.905, P = 0.016], within 48 h [OR = 5.587, P = 0.008], and within 72 h [OR = 2.858, P = 0.011] increased the risk of NEC.

Conclusion: Both severe anemia and RBC transfusion appears to increase the risk of NEC in VLBW infants. The early prevention and treatment of anemia, strict evaluation of the indications for transfusion and enhanced monitoring after transfusion is encouraged in the NICU.

Citing Articles

[Clinical practice guidelines for the diagnosis and treatment of anemia of prematurity (2025)].

Zhongguo Dang Dai Er Ke Za Zhi. 2025; 27(1):1-17.

PMID: 39825646 PMC: 11750247. DOI: 10.7499/j.issn.1008-8830.2407094.

Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis: A Secondary Analysis of a Randomized Clinical Trial.

Salas A, Gunn E, Carlo W, Bell E, Das A, Josephson C JAMA Netw Open. 2024; 7(5):e249643.

PMID: 38700862 PMC: 11069076. DOI: 10.1001/jamanetworkopen.2024.9643.

Factors influencing necrotizing enterocolitis in premature infants in China: a systematic review and meta-analysis.

Zhao S, Jiang H, Miao Y, Liu W, Li Y, Liu H BMC Pediatr. 2024; 24(1):148.

PMID: 38418993 PMC: 10903018. DOI: 10.1186/s12887-024-04607-3.

Association between bronchopulmonary dysplasia and death or neurodevelopmental impairment at 3 years in preterm infants without severe brain injury.

Li W, Wang Y, Song J, Zhang C, Xu Y, Xu F Front Neurol. 2023; 14:1292372.

PMID: 38033771 PMC: 10684711. DOI: 10.3389/fneur.2023.1292372.

Banked term umbilical cord blood to meet the packed red blood cell transfusion needs of extremely-low-gestational-age neonates: a feasibility analysis.

Christensen R, Bahr T, Christensen T, Ohls R, Krong J, Carlton L J Perinatol. 2023; 44(6):873-879.

PMID: 38030793 DOI: 10.1038/s41372-023-01833-y.

References

Sharma R, Kraemer D, Torrazza R, Mai V, Neu J, Shuster J . Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants. J Perinatol. 2014; 34(11):858-62. PMC: 4584142. DOI: 10.1038/jp.2014.59. View

Walsh M, Kliegman R . Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986; 33(1):179-201. PMC: 7131118. DOI: 10.1016/s0031-3955(16)34975-6. View

Nino D, Sodhi C, Hackam D . Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 2016; 13(10):590-600. PMC: 5124124. DOI: 10.1038/nrgastro.2016.119. View

Hay S, Zupancic J, Flannery D, Kirpalani H, Dukhovny D . Should we believe in transfusion-associated enterocolitis? Applying a GRADE to the literature. Semin Perinatol. 2016; 41(1):80-91. DOI: 10.1053/j.semperi.2016.09.021. View

Patel R, Kandefer S, Walsh M, Bell E, Carlo W, Laptook A . Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med. 2015; 372(4):331-40. PMC: 4349362. DOI: 10.1056/NEJMoa1403489. View

Wallenstein M, Arain Y, Birnie K, Andrews J, Palma J, Benitz W . Red blood cell transfusion is not associated with necrotizing enterocolitis: a review of consecutive transfusions in a tertiary neonatal intensive care unit. J Pediatr. 2014; 165(4):678-82. PMC: 4845907. DOI: 10.1016/j.jpeds.2014.06.012. View

Cunningham K, Okolo F, Baker R, Mollen K, Good M . Red blood cell transfusion in premature infants leads to worse necrotizing enterocolitis outcomes. J Surg Res. 2017; 213:158-165. PMC: 5467453. DOI: 10.1016/j.jss.2017.02.029. View

Singh R, Visintainer P, Frantz 3rd I, Shah B, Meyer K, Favila S . Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants. J Perinatol. 2011; 31(3):176-82. PMC: 3234132. DOI: 10.1038/jp.2010.145. View

Lee J, Park K, Kim A, Yang H, Jung E, Cho S . Maternal and Placental Risk Factors for Developing Necrotizing Enterocolitis in Very Preterm Infants. Pediatr Neonatol. 2016; 58(1):57-62. DOI: 10.1016/j.pedneo.2016.01.005. View

10.

Luig M, Lui K . Epidemiology of necrotizing enterocolitis--Part II: Risks and susceptibility of premature infants during the surfactant era: a regional study. J Paediatr Child Health. 2005; 41(4):174-9. DOI: 10.1111/j.1440-1754.2005.00583.x. View

11.

Garg P, Pinotti R, Lal C, Salas A . Transfusion-associated necrotizing enterocolitis in preterm infants: an updated meta-analysis of observational data. J Perinat Med. 2017; 46(6):677-685. DOI: 10.1515/jpm-2017-0162. View

12.

Sood B, Rambhatla A, Thomas R, Chen X . Decreased hazard of necrotizing enterocolitis in preterm neonates receiving red cell transfusions. J Matern Fetal Neonatal Med. 2015; 29(5):737-44. DOI: 10.3109/14767058.2015.1016422. View

13.

Stritzke A, Smyth J, Synnes A, Lee S, Shah P . Transfusion-associated necrotising enterocolitis in neonates. Arch Dis Child Fetal Neonatal Ed. 2012; 98(1):F10-4. DOI: 10.1136/fetalneonatal-2011-301282. View

14.

Wiedmeier S, Henry E, Sola-Visner M, Christensen R . Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. J Perinatol. 2008; 29(2):130-6. DOI: 10.1038/jp.2008.141. View

15.

Lambert D, Christensen R, Baer V, Henry E, Gordon P, Besner G . Fulminant necrotizing enterocolitis in a multihospital healthcare system. J Perinatol. 2011; 32(3):194-8. DOI: 10.1038/jp.2011.61. View

16.

Jasani B, Rao S, Patole S . Withholding Feeds and Transfusion-Associated Necrotizing Enterocolitis in Preterm Infants: A Systematic Review. Adv Nutr. 2017; 8(5):764-769. PMC: 5593105. DOI: 10.3945/an.117.015818. View

17.

Han S, Hong C, Knell J, Edwards E, Morrow K, Soll R . Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis. J Pediatr Surg. 2020; 55(6):998-1001. DOI: 10.1016/j.jpedsurg.2020.02.046. View

18.

Mohamed A, Shah P . Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics. 2012; 129(3):529-40. DOI: 10.1542/peds.2011-2872. View

19.

Ozcan B, Aydemir O, Ulubas Isik D, Bas A, Demirel N . Severe Anemia Is Associated with Intestinal Injury in Preterm Neonates. Am J Perinatol. 2019; 37(6):603-606. DOI: 10.1055/s-0039-1683982. View

20.

Sharma R, Hudak M . A clinical perspective of necrotizing enterocolitis: past, present, and future. Clin Perinatol. 2013; 40(1):27-51. PMC: 3575605. DOI: 10.1016/j.clp.2012.12.012. View