Abstract
BackgroundThe 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.MethodsThe 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.ResultsThe 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.ConclusionBoth 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.
Highlights
Neonatal necrotizing enterocolitis (NEC) is a common complication and leading cause of death in neonates, especially in very low birth weight (VLBW) infants with a mortality of 20– 30% [1, 2]
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. Both severe anemia and RBC transfusion appears to increase the risk of NEC in VLBW infants
In the multivariate logistic regression models adjusting for placental abruption and UVC/ peripherally inserted central catheter (PICC), we found 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 in VLBW infants (Table 4)
Summary
Neonatal necrotizing enterocolitis (NEC) is a common complication and leading cause of death in neonates, especially in very low birth weight (VLBW) infants with a mortality of 20– 30% [1, 2]. Other studies showed no association between RBC transfusion and NEC [13,14,15]. Some studies highlighted that severe anemia, not the transfusion event, was associated with the risk of developing NEC [17, 18]. We hypothesized that severe anemia or RBC transfusion could be a risk factor for NEC. To prove this hypothesis, we conducted a retrospective case-control study to analyse the association of severe anemia or RBC transfusion and the development of NEC in neonates. 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
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