Dataset Information

Effect of birth weight on the association between necrotising enterocolitis and red blood cell transfusions in <=1500 g infants.

ABSTRACT:

Context

Reports evaluating a possible association between necrotising enterocolitis (NEC) and blood transfusion have been predominantly case-control studies. As the possible associations of disease with any variable on which cases and controls have been matched cannot be explored, a cohort study would offer a solution to this problem.

Objective

Our objective was to evaluate the association between exposure to a packed red blood cell (PRBC) transfusion and development of NEC in a cohort where biases of matching are omitted.

Design

In a retrospective cohort, exposed infants were defined as those who received a transfusion and did not develop NEC or developed NEC within 48 h of the transfusion. All others were considered unexposed.

Setting

A single regional perinatal centre in Memphis, Tennessee, USA.

Patients

3060 ?1500 g birth weights (BW) were included.

Outcome measures

The relative risk of developing NEC after exposure to a PRBC transfusion was measured.

Results

3060 infants were identified. 174 infants (5.7%) developed NEC; 116 of the 174 infants (67%) were exposed. NEC infants had a significantly lower BW (924 vs 1042 g) and required a longer stay on a ventilator (7 vs 2 days). Divided into groups, infants with BW ?750 , 751-1000 , 1001-1250 g and 1251-1500 g (n=52, 51, 46 and 25, respectively) had a relative risk of 0.14, 0.46, 1.83 and 1.78 (p<0.01, 0.02, 0.07 and 0.17), respectively, to develop NEC after an exposure. Infants with longest ventilator days were also significantly less likely to develop NEC after an exposure; relative risk=0.11 (p<0.01).

Conclusions

Exposure to transfusions was less likely associated with NEC in ?1000 g infants and remained a risk factor in 1001-1500 infants. BW has to be factored in any study evaluating the association between PRBC transfusions and NEC.

SUBMITTER: Elabiad MT

PROVIDER: S-EPMC3845042 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Publications

Effect of birth weight on the association between necrotising enterocolitis and red blood cell transfusions in <=1500 g infants.

Elabiad Mohamad Tammam MT Harsono Mimily M Talati Ajay J AJ Dhanireddy Ramasubbareddy R

BMJ open 20131127 11

<h4>Context</h4>Reports evaluating a possible association between necrotising enterocolitis (NEC) and blood transfusion have been predominantly case-control studies. As the possible associations of disease with any variable on which cases and controls have been matched cannot be explored, a cohort study would offer a solution to this problem.<h4>Objective</h4>Our objective was to evaluate the association between exposure to a packed red blood cell (PRBC) transfusion and development of NEC in a c ...[more]

PMID: 24285632

Similar Datasets

Project description:Data regarding the contribution of red blood cell (RBC) transfusion and anemia to necrotizing enterocolitis (NEC) are conflicting. These associations have not been prospectively evaluated, accounting for repeated, time-varying exposures.To determine the relationship between RBC transfusion, severe anemia, and NEC.In a secondary, prospective, multicenter observational cohort study from January 2010 to February 2014, very low-birth-weight (VLBW, ?1500 g) infants, within 5 days of birth, were enrolled at 3 level III neonatal intensive care units in Atlanta, Georgia. Two hospitals were academically affiliated and 1 was a community hospital. Infants received follow-up until 90 days, hospital discharge, transfer to a non-study-affiliated hospital, or death (whichever came first). Multivariable competing-risks Cox regression was used, including adjustment for birth weight, center, breastfeeding, illness severity, and duration of initial antibiotic treatment, to evaluate the association between RBC transfusion, severe anemia, and NEC.The primary exposure was RBC transfusion. The secondary exposure was severe anemia, defined a priori as a hemoglobin level of 8 g/dL or less. Both exposures were evaluated as time-varying covariates at weekly intervals.Necrotizing enterocolitis, defined as Bell stage 2 or greater by preplanned adjudication. Mortality was evaluated as a competing risk.Of 600 VLBW infants enrolled, 598 were evaluated. Forty-four (7.4%) infants developed NEC. Thirty-two (5.4%) infants died (all cause). Fifty-three percent of infants (319) received a total of 1430 RBC transfusion exposures. The unadjusted cumulative incidence of NEC at week 8 among RBC transfusion-exposed infants was 9.9% (95% CI, 6.9%-14.2%) vs 4.6% (95% CI, 2.6%-8.0%) among those who were unexposed. In multivariable analysis, RBC transfusion in a given week was not significantly related to the rate of NEC (adjusted cause-specific hazard ratio, 0.44 [95% CI, 0.17-1.12]; P?=?.09). Based on evaluation of 4565 longitudinal measurements of hemoglobin (median, 7 per infant), the rate of NEC was significantly increased among VLBW infants with severe anemia in a given week compared with those who did not have severe anemia (adjusted cause-specific hazard ratio, 5.99 [95% CI, 2.00-18.0]; P?=?.001).Among VLBW infants, severe anemia, but not RBC transfusion, was associated with an increased risk of NEC. Further studies are needed to evaluate whether preventing severe anemia is more important than minimizing RBC transfusion.

Dataset Information

Effect of birth weight on the association between necrotising enterocolitis and red blood cell transfusions in <=1500 g infants.

Context

Objective

Design

Setting

Patients

Outcome measures

Results

Conclusions

Publications

Effect of birth weight on the association between necrotising enterocolitis and red blood cell transfusions in <=1500 g infants.

Similar Datasets

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