Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants

Objective: To determine association of anemia and red blood cell (RBC) transfusions with necrotizing enterocolitis (NEC) in preterm infants. Study Design: A total of 111 preterm infants with NEC >= stage 2a were compared with 222 matched controls. In all, 28 clinical variables, including hematocrit (Hct) and RBC transfusions were recorded. Propensity scores and multivariate logistic regression models were created to examine effects on the risk of NEC. Result: Controlling for other factors, lower Hct was associated with increased odds of NEC (odds ratio (OR) = 1.10, P = 0.01). RBC transfusion has a temporal relationship with NEC onset. Transfusion within 24 h (OR = 7.60, P = 0.001) and 48 h (OR = 5.55, P = 0.001) has a higher odds of developing NEC but this association is not significant by 96 h (OR = 2.13, P = 0.07), post-transfusion. Conclusion: Anemia may increase the risk of developing NEC in preterm infants. RBC transfusions are temporally related to NEC. Prospective studies are needed to better evaluate the potential influence of transfusions on the development of NEC. Journal of Perinatology (2011) 31, 176-182; doi:10.1038/jp.2010.145; published online 27 January 2011