Association of Red Blood Transfusion With Necrotizing Enterocolitis in Very Low Birth-Weight Neonates: A 7-Year Retrospective Cohort Study in Saudi Arabia

ABSTRACT Background: Necrotizing enterocolitis (NEC) is a multifactorial disorder of the gastrointestinal tract of very low birth-weight (VLBW) infants. Blood transfusions are suspected to be associated with NEC in this population. Purpose: To examine the association between packed red blood cells (PRBCs) transfusion and NEC in VLBW neonates (less than 1500 gm) or less than 32 weeks. Methods: A retrospective cohort study of all VLBW neonates admitted to the neonatal intensive care unit (NICU) at King Abdulaziz University Hospital (KAUH) from January 1, 2014, to December 31, 2020. Results: Of 3018 newborns admitted to the NICU, 441 were VLBW neonates born at less than 32 weeks of gestational age (mean: 29 weeks ± 2.3; male: 220, 49.9%). The sample was divided into 2 groups: those who developed NEC 49 (11.1%) and those who did not develop NEC 392 (88.9%). Infants who developed NEC had significantly lower birth weight, gestational age (GA), and initial hematocrit ( P < 0.05). Although blood transfusions were more often noted in those who developed NEC 7.4% versus 32.1% ( P < 0.01), only sepsis showed significant associations with NEC, OR 8.2 (3.893–17.259) after adjusting for other studied risk factors. Implication for Practice and Research: PRBC transfusion was not associated with an increased risk of NEC in VLBW neonates. Sepsis was the only variable found to be significantly associated with NEC. Future prospective cohort studies to assess the role of anemia, the timing of PRBC transfusion, and the number of transfusions on incidence of NEC are needed.