Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis
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Published:2024-05-03
Issue:5
Volume:7
Page:e249643
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Salas Ariel A.1, Gunn Elizabeth1, Carlo Waldemar A.1, Bell Edward F.2, Das Abhik3, Josephson Cassandra D.45, Patel Ravi M.6, Tan Sylvia3, Kirpalani Haresh7, , Polin Richard A.8, Laptook Abbot R.8, Keszler Martin8, Hensman Angelita M.8, Little Emily8, St. Pierre Lucille8, Vieira Elisa8, Walsh Michele C.8, Hibbs Anna Maria8, Newman Nancy S.8, Payne Allison H.8, Wilson-Costello Deanne E.8, Siner Bonnie S.8, Bhola Monika8, Yalcinkaya Gulgun8, Truog William E.8, Pallotto Eugenia K.8, Kilbride Howard W.8, Gauldin Cheri8, Holmes Anne8, Johnson Kathy8, Scott Allison8, Poindexter Brenda B.8, Merhar Stephanie L.8, Schibler Kurt8, Grisby Cathy8, Kirker Kristin8, Wuertz Sandra8, Jackson Lenora8, Muthig Greg8, Dudley Juanita8, Whyte Robin K.8, Cotten C. Michael8, Goldberg Ronald N.8, Goldstein Ricki F.8, Malcolm William F.8, Ashley Patricia L.8, Mago-Shah Deesha8, Warren Mollie8, Finkle Joanne8, Fisher Kimberley A.8, Gustafson Kathryn E.8, Laughon Matthew M.8, Bose Carl L.8, Bernhardt Janice8, Wereszczak Janice8, Warner Diane8, Talbert Jennifer8, Clark Cindy8, Kicklighter Stephen D.8, Bentley Alexandra8, Edwards Laura8, Rhodes-Ryan Ginger8, White Donna8, Patel Ravi M.8, Carlton David P.8, Stoll Barbara J.8, Adams-Chapman Ira8, Loggins Yvonne8, Hale Ellen C.8, Bottcher Diane8, Carter Sheena L.8, Kendrick-Allwood Salathiel8, Mulligan LaRossa Maureen8, Mackie Colleen8, Smikle Gloria8, Comerford Lynn C.8, Higgins Rosemary D.8, Bremer Andrew A.8, Wilson Archer Stephanie8, Sokol Gregory M.8, Harmon Heidi8, Papile Lu Ann8, Hines Abbey C.8, Herron Dianne E.8, Gunn Susan8, Smiley Lucy8, Joyce Jeff8, Zupancic John A. F.8, Kennedy Kathleen A.8, Tyson Jon E.8, Khan Amir M.8, Arldt-McAlister Julie8, Eason Elizabeth8, Garcia Carmen8, Hall Donna J.8, Martin Karen8, McDavid Georgia E.8, Rodgers Shawna L.8, Stephens Emily K.8, Wright Sharon L.8, Mondoro Traci H.8, Levy Catherine8, Sánchez Pablo J.8, Nelin Leif D.8, Maitre Nathalie L.8, Seabrook Ruth B.8, Jadcherla Sudarshan R.8, Luzader Patricia8, Fortney Christine A.8, Gutentag Julie8, Timan Christopher J.8, Small Kristi8, Sullivan Rox Ann8, Yoseff-Salameh Lina8, McCool Jacqueline8, Stein Melanie8, Fearns Erin8, Fowler Aubrey8, Grothause Jennifer8, Burkhardt Stephanie8, Purnell Jessica8, Nelin Mary Ann8, Carey Helen8, Pietruszewski Lindsay8, Sullivan Margaret8, Shadd Julie8, Notestine Jennifer8, Hague Cole8, Clark Erna8, Chao Michelle8, Park Courtney8, Baugher Hallie8, Beckford Demi R.8, Miller Bethany8, Marzec Laura8, Warnimont Kyrstin8, Bann Carla M.8, Gantz Marie G.8, Brambilla Donald J.8, Newman Jamie E.8, Gabrio Jenna8, Crawford Margaret M.8, Petrie Huitema Carolyn M.8, O’Donnel Auman Jeanette8, Leblond David8, vonLehmden Annie8, Wallace Dennis8, Zaterka-Baxter Kristin M.8, Van Meurs Krisa P.8, Stevenson David K.8, Hintz Susan R.8, Ball M. Bethany8, Chock Valerie Y.8, Bentley Barbara8, DeAnda Maria Elena8, DeBattista Anne M.8, Earhart Beth8, Huffman Lynne C.8, Krueger Casey E.8, Lucash Ryan E.8, Proud Melinda S.8, Reichert Elizabeth N.8, Taylor Heather8, Weiss Hali E.8, Ambalavanan Namasivayam8, Collins Monica V.8, Cosby Shirley S.8, Carcelen Myriam Peralta8, Biasini Fred J.8, Johnston Kristen C.8, Moses Mary Beth8, McNair Tara E.8, Phillips Vivien A.8, Rector Richard V.8, Whitley Sally8, Domnanovich Kristy A.8, York Chapman Sheree8, Devaskar Uday8, Garg Meena8, Purdy Isabell B.8, Chanlaw Teresa8, Geller Rachel8, Colaizy Tarah T.8, Brumbaugh Jane E.8, Widness John A.8, Harmon Heidi M.8, Johnson Karen J.8, Walker Jacky R.8, Goeke Claire A.8, Eastman Diane L.8, Watterberg Kristi L.8, Ohls Robin K.8, Backstrom Lacy Conra8, Fuller Janell8, Hanson Mary8, Hartenberger Carol8, Kuan Elizabeth8, Lowe Jean R.8, Sundquist Beauman Sandra8, Schmidt Barbara8, DeMauro Sara B.8, Abbasi Soraya8, Mancini Toni8, Cucinotta Dana M.8, Snyder Jonathan8, Chaudhary Aasma S.8, D’Angio Carl T.8, Guillet Ronnie8, Carmen Melissa F.8, Myers Gary J.8, Binion Kyle8, Fallone Caitlin8, Farooq Osman8, Hunn Julianne8, Jensen Rosemary L.8, Merzbach Joan8, Orme Constance8, Scorsone Ann Marie8, Wadkins Holly I. M.8, Yost Kelley8, Lakshminrusimha Satyan8, Reynolds Anne Marie8, Guilford Stephanie8, Hartley-McAndrews Michelle E.8, Williams Ashley8, Zorn William8, Rowan Mary8, Maffett Dee8, Prinzing Diane8, Bowman Melissa8, Sacilowski Michael8, Rochesz Daisy8, Wyckoff Myra H.8, Brion Luc P.8, Heyne Roy J.8, Vasil Diana M.8, Adams Sally S.8, De Leon Maria M.8, Eubanks Frances8, Guzman Alicia8, Heyne Elizabeth8, Lee Lizette E.8, Madden Linda A.8, Pavageau Lara8, Sepulveda Pollieanna8, Twell Boatman Cathy8, Tolentino-Plata Kristine8, Yoder Bradley A.8, Baserga Mariana8, Minton Stephen D.8, Sheffield Mark J.8, Rau Carrie A.8, Burnett Jill8, Christensen Susan8, Cole Bledsoe Laura8, Elmont Jennifer O.8, Marchant Trisha8, Maxson Earl8, McGrath Kandace M.8, Mickelsen Hena G.8, Parry D. Melody8, Reich Brixen A.8, Schaefer Susan T.8, Weaver-Lewis Kimberlee8, Woodbury Kathryn D.8, Shankaran Seetha8, Sood Beena G.8, Chawla Sanjay8, Bara Rebecca8, Agarwal Prashant8, Bajaj Monika8, Childs Kirsten8, February Melissa8, Goldston Laura8, Johnson Mary E.8, Natarajan Girija8, Panaitescu Bogdan8, Woldt Eunice8, Barks John8, Carlson Martha8, White Diane F.8
Affiliation:
1. Department of Pediatrics, University of Alabama at Birmingham 2. Department of Pediatrics, University of Iowa, Iowa City 3. Statistical and Environmental Sciences Unit, RTI International, Washington, DC 4. Cancer and Blood Disorders Institute and Blood Bank/Transfusion Medicine, Johns Hopkins All Children’s Hospital, St Petersburg, Florida 5. Department of Oncology, John Hopkins University School of Medicine, Baltimore, Maryland 6. Department of Pediatrics, Emory University, Atlanta, Georgia 7. Department of Pediatrics, University of Pennsylvania, Philadelphia 8. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network
Abstract
ImportanceObservational studies often report that anemia and red blood cell (RBC) transfusions are associated with a higher risk of necrotizing enterocolitis (NEC) among extremely low-birthweight (ELBW) infants.ObjectiveTo evaluate whether there is a temporal association between 72-hour hazard periods of exposure to RBC transfusions and NEC among ELBW infants randomized to either higher or lower hemoglobin transfusion thresholds.Design, Setting, and ParticipantsThis post hoc secondary analysis of 1690 ELBW infants who survived to postnatal day 10 enrolled in the Transfusion of Prematures (TOP) randomized multicenter trial between December 1, 2012, and April 12, 2017, was performed between June 2021 and July 2023.ExposuresFirst, the distribution of RBC transfusions and the occurrence of NEC up to postnatal day 60 were examined. Second, 72-hour posttransfusion periods were categorized as hazard periods and the pretransfusion periods of variable duration as control periods. Then, the risk of NEC in posttransfusion hazard periods was compared with that in pretransfusion control periods, stratifying the risk based on randomization group (higher or lower hemoglobin transfusion threshold group).Main Outcomes and MeasuresThe primary outcome was incidence of NEC stage 2 or 3. Secondary outcomes included the incidence rates of NEC within five 10-day intervals, taking into account the number of days at risk.ResultsOf 1824 ELBW infants randomized during the TOP trial, 1690 were included in the present analysis (mean [SD] gestational age, 26.0 [1.5] weeks; 899 infants [53.2%] were female). After categorizing 4947 hazard periods and 5813 control periods, we identified 133 NEC cases. Fifty-nine of these cases (44.4%) occurred during hazard periods. Baseline and clinical characteristics of infants with NEC during hazard periods did not differ from those of infants with NEC during control periods. The risk of NEC was 11.9 per 1000 posttransfusion hazard periods and 12.7 per 1000 control periods (adjusted risk ratio, 0.95; 95% CI, 0.68-1.32; P = .74). This risk did not differ significantly between randomization groups, but the incidence rate of NEC per 1000 days peaked between postnatal days 20 and 29 in the lower hemoglobin transfusion threshold group.Conclusions and RelevanceThe findings of this post hoc analysis suggest that, among ELBW infants with the hemoglobin ranges occurring in the TOP trial, exposure to RBC transfusions was not temporally associated with a higher risk of NEC during 72-hour posttransfusion hazard periods. Given that the incidence rate of NEC peaked between postnatal days 20 and 29 among infants with lower hemoglobin values, a more in-depth examination of this at-risk period using larger data sets is warranted.Trial RegistrationClinicalTrials.gov Identifier: NCT01702805
Publisher
American Medical Association (AMA)
Cited by
1 articles.
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