Necrotizing enterocolitis (NEC) affects approximately 1 in 1000 premature babies, usually two to six weeks after birth, and accounts for 10% of neonatal deaths. Although the pathogenesis of NEC is not well understood, observational studies report that both anemia and RBC transfusions are associated with a higher risk of NEC. Data from the Transfusion of Prematures (TOP) randomized clinical trial, however, randomized extremely low-birthweight (ELBW) infants to receive RBC transfusions at higher or lower transfusion thresholds and found that infants who received more RBC transfusions did not have a higher risk of NEC. New secondary analysis of this data examined whether there is an increased risk of NEC immediately following a transfusion. Of the 1690 ELBW infants (mean gestational age, 26 weeks; birth weight, 765g; 53% female) in the TOP trial, 133 (8%) developed NEC 10 to 60 days after birth and received a mean of five RBC transfusions/infant. During the 72 hours following RBC transfusion (i.e., hazard period), 59 infants (44%) developed NEC compared to 74 infants (56%) in the control periods (before transfusions and 72 hours afterwards) (adjusted risk ratio, 0.95; 95% C.I., 0.68 to 1.32) suggesting there is not an association between RBC transfusions and NEC. The incidence of NEC was highest, though, 20 to 29 days after birth among infants with lower hemoglobin values. The pathogenesis and risk factors associated with NEC requires further study.
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