Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
BMJ Open. 2013 Nov 27;3(11):e003823. doi: 10.1136/bmjopen-2013-003823.
Reports evaluating a possible association between necrotising enterocolitis (NEC) and blood transfusion have been predominantly case-control studies. As the possible associations of disease with any variable on which cases and controls have been matched cannot be explored, a cohort study would offer a solution to this problem.
Our objective was to evaluate the association between exposure to a packed red blood cell (PRBC) transfusion and development of NEC in a cohort where biases of matching are omitted.
In a retrospective cohort, exposed infants were defined as those who received a transfusion and did not develop NEC or developed NEC within 48 h of the transfusion. All others were considered unexposed.
A single regional perinatal centre in Memphis, Tennessee, USA.
3060 ≤1500 g birth weights (BW) were included.
The relative risk of developing NEC after exposure to a PRBC transfusion was measured.
3060 infants were identified. 174 infants (5.7%) developed NEC; 116 of the 174 infants (67%) were exposed. NEC infants had a significantly lower BW (924 vs 1042 g) and required a longer stay on a ventilator (7 vs 2 days). Divided into groups, infants with BW ≤750 , 751-1000 , 1001-1250 g and 1251-1500 g (n=52, 51, 46 and 25, respectively) had a relative risk of 0.14, 0.46, 1.83 and 1.78 (p<0.01, 0.02, 0.07 and 0.17), respectively, to develop NEC after an exposure. Infants with longest ventilator days were also significantly less likely to develop NEC after an exposure; relative risk=0.11 (p<0.01).
Exposure to transfusions was less likely associated with NEC in ≤1000 g infants and remained a risk factor in 1001-1500 infants. BW has to be factored in any study evaluating the association between PRBC transfusions and NEC.
评估坏死性小肠结肠炎（NEC）与输血之间可能存在关联的报告主要是病例对照研究。由于不能探讨病例和对照匹配的任何变量与疾病的可能关联，因此队列研究将解决这一问题。
我们的目的是评估在一个排除了匹配偏倚的队列中，暴露于红细胞悬液（PRBC）输血与 NEC 发展之间的关联。
在回顾性队列中，暴露组的婴儿定义为接受输血且未在输血后 48 小时内发生 NEC 或发生 NEC 的婴儿。其余婴儿均视为未暴露组。
美国田纳西州孟菲斯市的一个区域性围产期中心。
纳入体重为 3060g 至 1500g 的婴儿。
测量接受 PRBC 输血后发生 NEC 的相对风险。
共确定了 3060 名婴儿。174 名婴儿（5.7%）发生了 NEC；174 名婴儿中有 116 名（67%）暴露。NEC 婴儿的体重明显较低（924g 与 1042g），且需要更长时间的呼吸机通气（7 天与 2 天）。分为以下几组：体重≤750g、751-1000g、1001-1250g 和 1251-1500g 的婴儿（分别为 52、51、46 和 25 名）发生 NEC 的相对风险分别为 0.14、0.46、1.83 和 1.78（p<0.01、0.02、0.07 和 0.17）。暴露于输血后，通气时间最长的婴儿发生 NEC 的可能性也明显降低；相对风险=0.11（p<0.01）。
在≤1000g 的婴儿中，输血暴露与 NEC 的相关性较低，但在 1001-1500g 的婴儿中仍是一个危险因素。在评估 PRBC 输血与 NEC 之间的关联时，必须考虑体重因素。
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