Development of necrotizing enterocolitis after blood transfusion in very premature neonates

Adverse outcomes after red blood cell transfusion in very low birth weight infants in a resource-restricted hospital

BACKGROUND

Red blood cell transfusions (RBCTs) in preterm infants are associated with various adverse outcomes including transfusion-associated necrotizing enterocolitis (TANEC) and transfusion-related late-onset sepsis (TR-LOS). This study aimed to determine the adverse outcomes of RBCTs in very low birth weight infants (VLBWI) at a resource-restricted hospital in Cape Town, South Africa.

STUDY DESIGN AND METHODS

A retrospective descriptive analysis of all VLBWI who received a RBCT in 2020 was performed. Univariate and multivariate logistic regression were performed to determine the association of adverse events after single, multiple, early, and late RBCTs.

RESULTS

The study cohort included 178 VLBWI, representing a RBCT prevalence of 22.2%. The mean gestational age was 28 weeks and the mean birth weight was 0.99 kg. The first RBCT occurred at a mean of 27 days and at an Hb <8 g/dL, differing significantly between single, multiple early, and late RBCT groups. After adjusting for confounders, multiple RBCTs showed a strong association with TR-LOS within 3 days (aOR 9.22, 95th CI 2.30; 36.91, p = .002), TR-LOS within 7 days (aOR 8.39, 95th CI 2.72; 25.89, p < .001), any NEC ≥ Bell stage 2 (aOR 2.34, 95th CI 1.66; 11.78, p = .026), BPD (aOR 3.62, 95th CI 1.37; 9.54, p = .009) and mortality (aOR 3.58, 95th CI 1.39; 9.22, p = .008). After adjusting for confounders, early RBCTs were strongly associated with mortality (aOR 2.47, 95th CI 1.28; 8.90, p = .013).

DISCUSSION

Multiple RBCTs may be associated with TR-related sepsis. This requires more research in resource-restricted areas with a high burden of disease.

Surgical necrotizing enterocolitis risk factors in extremely preterm infants: a Korean nationwide cohort study

BACKGROUND

The incidence of necrotizing enterocolitis (NEC) is significantly associated with gestational age (GA). This study aimed to investigate risk factors for surgically treated NEC (sNEC) in extremely preterm infants (EPIs) using nationwide cohort registry.

METHODS

Data were collected from 16,338 very-low-birth-weight infants registered in the Korean neonatal network. Clinical data of 5310 EPIs were retrospectively analyzed. sNEC was defined as infants with diagnosis of NEC requiring surgical treatment, who underwent surgical intervention for NEC or died before surgery. Infants were categorized into three groups based on their NEC status: infants without NEC (control), medically treated NEC (mNEC), and sNEC. These groups were matched based on GA to investigate risk factors for NEC.

RESULTS

In EPIs, small for gestational age (SGA; odds ratio 1.68, 95% confidence interval [CI], 1.17-2.36, p = 0.004), hypotension (1.49, 1.18-1.89, p = 0.001), and IVH (1.63, 1.30-2.05, p < 0.001) were identified as risk factors for sNEC. Complete administration of antenatal steroid reduced the risk of sNEC (0.80, 0.64-0.99, p = 0.044).

CONCLUSION

Our study demonstrated that EPIs who are SGA, and experience hypotension and IVH may be at an increased risk of developing NEC requiring surgery. These groups require close attention and monitoring for any signs of surgical indications of NEC.

IMPACT

This nationwide cohort study aimed to identify characteristics of infants with necrotizing enterocolitis (NEC) among extremely preterm infants (EPIs) and analyze the risk factors associated with NEC requiring surgical intervention. Small for gestational age (SGA), hypotension, and intraventricular hemorrhage (IVH) were identified as significant risk factors for surgically treated NEC (sNEC) in EPIs. The administration of antenatal steroids decreases the risk of sNEC. Close attention and monitoring for EPIs with early identifiable risk factors such as SGA, hypotension, and IVH should be considered to prevent and detect sNEC early, ultimately leading to improved long-term outcomes.

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

The 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.

Banked term umbilical cord blood to meet the packed red blood cell transfusion needs of extremely-low-gestational-age neonates: a feasibility analysis

OBJECTIVES

To assess the feasibility of drawing, processing, safety-testing, and banking term umbilical cord blood to meet the packed red blood cell transfusion (RBC Tx) needs of extremely-low-gestational-age neonates (ELGANs).

DESIGN

(1) Retrospectively analyze all ELGANs RBC Tx over the past three years, (2) Estimate local cord blood availability, (3) Assess interest in this project, and implementation barriers, through stakeholder surveys.

RESULTS

In three years we cared for 266 ELGANs; 165 (62%) received ≥1 RBC Tx. Annual RBC Tx averaged 197 (95% CI, 152-243). If 10% of our 10,353 annual term births had cord blood drawn and processed, and half of those tested were acceptable for Tx, collections would exceed the 95th % upper estimate for need by >four-fold. Interest exceeded 97%. Identified barriers included FDA approval, training to collect cord blood, and cost.

CONCLUSION

RBC Tx needs of ELGANS could be met by local cord blood collection.