Associations between Red Blood Cell Transfusions and Necrotizing Enterocolitis in Very Low Birth Weight Infants

Abstract

: Background: Necrotising enterocolitis (NEC) is a serious inflammation of the bowel which mostly affects preterm infants. Two to five percent of all admissions to the Neonatal Intensive Care Unit (NICU) are because of NEC. In 85% cases, NEC affects very low birth weight (VLBW) infants (<1500 g) and is a leading cause of mortality and morbidity in preterm neonates. This study aimed to analyze the association between NEC & red blood cell transfusion in very low birth weight in the Neonatal intensive care of Benha University Hospital &Benha Children Hospital. Methods: This was a retrospective case-control study that was conducted on Very Low Birth Weight Infants in Neonatal Intensive Care Units of Benha University Hospital and Benha Children Hospital from November 2018 to November 2020 to identify all infants diagnosed with second stage of NEC or more according to modified Bell„s criteria who were hospitalized to Benha University Hospital& Benha Children Hospital. The number of transfused patients, the frequency of transfusions per patient and the amount of transfused PRBC (ml) were compared in NEC and control groups. Results: The results showed that the frequency of blood transfusion during NICU admission was significantly higher in the NEC group compared to the control group, with a mean of 3.32 ± 0.84 in cases and 1.40 ± 0.55 in controls (P<0.001). regarding logistic regression analysis revealed that the frequency of blood transfusion during NICU admission was significant predictors for NEC patients (P<0.001). In our study, the volume of blood for each transfusion was significantly lower in NEC group compared to controls, with a mean of 17.69 ± 1.37 ml/kg in cases and 19.29 ± 1.23 ml/kg in controls (P<0.001). The total volume of red blood cells (RBC) transfused was also significantly higher in NEC group compared to controls, with a mean of 58.73 ± 15.43 ml/kg in cases and 26.78 ± 10.35 ml/kg in controls (P<0.001). regarding univariate logistic regression analysis revealed that volume of blood for each transfusion in ml/kg, Total volume of RBC in ml/kg was significant predictors for NEC cases (P<0.001), while in Multivariate logistic regression analysis none of these factors was significant predictors for it. Regarding outcome of studied groups, in NEC groups the survivors were 21 (44.7 %), non survivors were 26 (55.3%) while in control group the Survivors were 70 (72.9%) & non survivors were 21 cases (27.1%). Conclusion: Our study revealed that transfusion of red blood cells was significantly associated with the development of NEC in very low birth weight infants. The frequency of blood transfusion during NICU admission was significantly higher in the NEC group compared to the control group, and the total volume of RBC transfusion was also significantly higher in NEC group compared to controls.