RBC transfusion and necrotizing enterocolitis in very preterm infants: a multicenter observational study

Author:

Dang Dan,Gu Xinyue,Jiang Siyuan,Li Wenli,Zhou Wenhao,Cao Yun,Lee Shoo Kim,Wu Hui,Zhou Jianguo, , ,Lee Shoo Kim,Chen Chao,Du Lizhong, ,Chen Xiuyong,Zhang Huyan,Tian Xiuying,Shi Jingyun,Li Zhankui,Yang Chuanzhong,Liu Ling,Yang Zuming,Fu Jianhua,Ji Yong,Chen Dongmei,Yang Changyi,Chen Rui,Peng Xiaoming,Shan Ruobing,Han Shuping,Wu Hui,Wang Lili,Wei Qiufen,Li Mingxia,Dai Yiheng,Jiang Hong,Kang Wenqing,Gong Xiaohui,Zhong Xiaoyun,Shi Yuan,Jiang Shanyu,Sun Bing,Li Long,Lin Zhenlang,Liu Jiangqin,Pan Jiahua,Xia Hongping,Li Xiaoying,Xu Falin,Qiu Yinping,Ma Li,Yang Ling,He Xiaori,Li Yanhong,Zhuang Deyi,Zhang Qin,Dong Wenbin,Sun Jianhua,Liang Kun,Wang Huaiyan,Feng Jinxing,Chen Liping,Lin Xinzhu,Jiang Chunming,Nie Chuan,Zeng Linkong,Hei Mingyan,Zhu Hongdan,Mi Hongying,Yin Zhaoqing,Song Hongxia,Wang Hongyun,Li Dong,Gao Yan,Wang Yajuan,Dai Liying,Zhang Liyan,Li Yangfang,Zhang Qianshen,Ding Guofang,Wang Jimei,Chen Xiaoxia,Wang Zhen,Tang Zheng,Ma Xiaolu,Zhang Xiaomei,Zhang Xiaolan,Wu Fang,Chen Yanxiang,Wu Ying,Ting Joseph

Abstract

AbstractThe causal relationship between Packed red blood cell (RBC) transfusion and necrotizing enterocolitis (NEC) remains uncertain. This study aims to provide an exploration of transfusion and NEC in very preterm infants. Using data from the Chinese Neonatal Network cohort study between 2019 and 2021, the analysis focused on very preterm infants (with a birth weight of < 1500 g or a gestational age of < 32 weeks) who developed NEC after receiving transfusions. The time interval between the prior transfusion and NEC was analyzed. An uneven distribution of the time interval implies an association of transfusion and NEC. Additionally, multivariable logistic analysis was conducted to detect the prognosis of defined transfusion-associated NEC(TANEC). Of the 16,494 infants received RBC transfusions, NEC was noted in 1281 (7.7%) cases, including 409 occurred after transfusion. Notably, 36.4% (149/409) of post-transfusion NEC occurred within 2 days after transfusion. The time interval distribution showed a non-normal pattern (Shapiro–Wilk test, W = 0.513, P < 0.001), indicating a possible link between transfusion and NEC. TANEC was defined as NEC occurred within 2 days after transfusion. Infants with TANEC had a higher incidence of death (adjusted OR 1.69; 95% CI 1.08 to 2.64), severe bronchopulmonary dysplasia (adjusted OR 2.03; 95% CI 1.41 to 2.91) and late-onset sepsis (adjusted OR 2.06; 95% CI 1.37 to 3.09) compared with infants without NEC after transfusion. Unevenly high number of NEC cases after RBC transfusions implies transfusion is associated with NEC. TANEC is associated with a poor prognosis. Further research is warranted to enhance our understanding of TANEC.

Funder

National Natural Science Foundation of China

Jilin Provincial Department of Science and Technology

National Key Research and Development Program of China

Shanghai Science and Technology Commission's Scientific and Technological Innovation Action Plan

Canadian Institutes of Health Research

Publisher

Springer Science and Business Media LLC

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