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Early Hum Dev. 2014 May;90(5):237-40. doi: 10.1016/j.earlhumdev.2014.02.003. Epub 2014 Mar 2.

Feeding practices and other risk factors for developing transfusion-associated necrotizing enterocolitis.

Author information

1
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States.
2
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States; Duke Clinical Research Institute, Durham, NC, United States.
3
Duke University Transfusion Services, Durham, NC, United States.
4
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, NC, United States; Jean and George Brumley, Jr., Neonatal-Perinatal Research Institute, Duke University Hospital, Durham, NC, United States. Electronic address: michael.cotten@dm.duke.edu.

Abstract

AIMS:

The objective of this study is to determine the incidence of and risk factors for necrotizing enterocolitis (NEC) and transfusion-associated NEC (TANEC) in very-low-birth-weight (VLBW) infants pre/post implementation of a peri-transfusion feeding protocol.

STUDY DESIGN:

A retrospective cohort study was conducted including all inborn VLBW infants admitted to the Duke intensive care nursery from 2002 to 2010. We defined NEC using Bell's modified criteria IIA and higher and TANEC as NEC occurring within 48h of a packed red blood cell (pRBC) transfusion. We compared demographic and laboratory data for TANEC vs. other NEC infants and the incidence of TANEC pre/post implementation of our peri-transfusion feeding protocol. We also assessed the relationship between pre-transfusion hematocrit and pRBC unit age with TANEC.

RESULTS:

A total of 148/1380 (10.7%) infants developed NEC. Incidence of NEC decreased after initiating our peri-transfusion feeding protocol: 126/939 (12%) to 22/293 (7%), P=0.01. The proportion of TANEC did not change: 51/126 (41%) vs. 9/22 (41%), P>0.99. TANEC infants were smaller, more likely to develop surgical NEC, and had lower mean pre-transfusion hematocrits prior to their TANEC transfusions compared with all other transfusions before their NEC episode: 28% vs. 33%, P<0.001. Risk of TANEC was inversely related to pre-transfusion hematocrit: odds ratio 0.87 (0.79-0.95).

CONCLUSIONS:

Pre-transfusion hematocrit is inversely related to risk of TANEC, which suggests that temporally maintaining a higher baseline hemoglobin in infants most at risk of NEC may be protective. The lack of difference in TANEC pre-/post-implementation of our peri-transfusion feeding protocol, despite an overall temporal decrease in NEC, suggests that other unmeasured interventions may account for the observed decreased incidence of NEC.

KEYWORDS:

Anemia; Feeding; Necrotizing enterocolitis; Transfusion; Very low birth weight infants

PMID:
24598173
PMCID:
PMC4050434
DOI:
10.1016/j.earlhumdev.2014.02.003
[Indexed for MEDLINE]
Free PMC Article
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