Elective red cell transfusions for anemia of prematurity and
development of necrotizing enterocolitis in previously well preterm neonates:
Incidence and difficulties in proving a cause-effect relation
Affiliations: Department of Neonatal Paediatrics, KEM Hospital for
Women, University of Western Australia, Perth, Australia | Women and Infants Research Foundation, KEM Hospital
for Women, University of Western Australia, Perth, Australia
Note: [] Corresponding author: Sanjay Patole, MD, DCH, FRACP, DrPH,
Department of Neonatal Pediatrics, KEM Hospital for Women, 374 Bagot Road,
Subiaco, Perth, Western Australia 6008, Australia. Tel.: +8 93401260; Fax: +8
93401266; E-mail: sanjay.patole@health.wa.gov.au
Abstract: Objectives: Study the incidence of the unexpected development of
necrotizing enterocolitis (NEC) following an elective packed red blood cell
(PRBC) transfusion for anemia of prematurity (AOP) in previously stable,
growing preterm neonates. Methods: Retrospective analysis (Jan 2001–July
2006) of data on all admissions to our tertiary neonatal unit who received a
PBRC transfusion and/or had definite (Stage ⩾ II) NEC. Results: 7935
neonates were admitted over the study period including 4833 (61%) with
gestation <37 weeks (preterm). 793 preterm neonates received 2191 elective
PRBC transfusions (median 2, range 1–12) for AOP. Definite NEC occurred in 37
(0.8%) preterm neonates with 7 developing it within 48 hours of a PRBC
transfusion. Only 1/7 was a stable, and growing (without oxygen/respiratory
assistance, full feeds, otherwise well except for symptomatic AOP) neonate. Conclusion: Unexpected development of NEC following an elective PRBC
transfusion in a previously well and stable neonate was rare in our population
of high-risk neonates. Given the low incidence of NEC, and the range of
possible risk factors (e.g. free radicals, mesenteric ischemia, hypovolemia,
proinflammatory cytokines in the transfused product, prematurity, IGUR),
designing and conducting large prospective observational studies is very
difficult to prove a causal relation between PRBC transfusions and NEC.
