Department of Pediatrics, The George Washington University, Children's National Medical Center, Washington, DC 20037, USA.
J Perinatol. 2011 Mar;31(3):183-7. doi: 10.1038/jp.2010.157. Epub 2011 Jan 20.
Preliminary studies suggested an association between red blood cell (RBC) transfusion and necrotizing enterocolitis (NEC) in premature neonates. An advantageous effect of withholding feeds during transfusion has never been studied. We aimed, first, to determine whether preterm infants who developed NEC were more likely to be transfused in the 48 to 72 h before the diagnosis of NEC; second, to test if a strict policy of withholding feeds during transfusion would decrease the incidence of transfusion-associated NEC.
The study was conducted in two phases. Phase 1: a retrospective case-control study of premature low-birth weight (<32 weeks and <2500 g) infants who developed NEC over a 6-year period. Phase 2: a comparison study of the incidence of NEC during the 18-months preceding, and the 18 months following the change of practice to withholding feeds during RBC transfusion.
In the case-control study (25 infants with NEC and 25 controls), more infants in the NEC group received transfusions in the 48 and 72 h preceding diagnosis (56 vs 20% within 48 h, P=0.019; and 64 vs 24% within 72 h, P=0.01). The total number of transfusions and age of RBCs were not different between the two groups. Implementing the policy of withholding feeds during transfusion was associated with a decrease in the incidence of NEC from 5.3 to 1.3% (P=0.047).
Infants who developed NEC frequently received RBC transfusions in the 48 and 72 h preceding presentation of NEC. A strict policy of withholding feeds during transfusion may have a protective effect from NEC.
初步研究表明，早产儿的红细胞（RBC）输血与坏死性小肠结肠炎（NEC）之间存在关联。在输血期间禁食的有益影响从未被研究过。我们的目的首先是确定在 NEC 诊断前的 48 至 72 小时内是否更容易发生 NEC 的早产儿接受输血；其次，检验在输血期间严格执行禁食的策略是否会降低输血相关 NEC 的发生率。
该研究分两个阶段进行。第一阶段：对 6 年内发生 NEC 的极低出生体重（<32 周和<2500 克）早产儿进行回顾性病例对照研究。第二阶段：比较改变输血时禁食的做法前后 18 个月内 NEC 的发生率。
在病例对照研究（25 例 NEC 患儿和 25 例对照）中，更多的 NEC 组患儿在诊断前的 48 和 72 小时内接受输血（48 小时内分别为 56%和 20%，P=0.019；72 小时内分别为 64%和 24%，P=0.01）。两组之间的输血总数和 RBC 年龄没有差异。在输血期间执行禁食的政策与 NEC 发生率从 5.3%降至 1.3%（P=0.047）相关。
发生 NEC 的婴儿在出现 NEC 前的 48 和 72 小时内经常接受 RBC 输血。在输血期间严格执行禁食的政策可能对 NEC 具有保护作用。
