Rai Stientje Esther, Sidhu Amneet Kaur, Krishnan Rohin Jayaram
Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, ON, Canada.
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
J Perinat Med. 2018 Aug 28;46(6):665-676. doi: 10.1515/jpm-2017-0048.
Significant controversy exists surrounding the possible association between recent packed red blood cell (PRBC) transfusion and the subsequent development of necrotizing enterocolitis (NEC) in infants. Previous studies and meta-analyses reporting a statistically significant association led to a practice change to withhold enteral feeds in the peri-transfusion period in many centers in an effort to prevent NEC; however, results from more recent studies do not support the existence of an association and, thus, question the validity of this practice change.
This study aimed to perform a systematic review and meta-analysis to determine whether exposure to recent PRBC transfusion (defined as within 48 h) is associated with the subsequent development of NEC stage ≥II (Bell's criteria) in infants.
Medline, Embase, CINAHL, and the Cochrane Library were searched from inception to October 7, 2015. A gray literature search was also performed. Studies comparing the risk of NEC in infants exposed and unexposed to recent PRBC transfusion were included. Thirteen studies met eligibility criteria, and 10 (n=15,675 infants) were included in the meta-analysis. Three authors independently extracted data, and meta-analysis was performed using a random effects model.
We found a statistically significant 45% reduction in the unadjusted odds of NEC in infants exposed to a recent PRBC transfusion (odds ratio=0.55, 95% confidence interval=0.31-0.98).
Our results show a protective effect of recent PRBC transfusion on the subsequent development of NEC. The practice of withholding enteral feeds during the peri-transfusion period should be re-evaluated in light of these results.
近期输注浓缩红细胞（PRBC）与婴儿随后发生坏死性小肠结肠炎（NEC）之间可能存在的关联存在重大争议。先前的研究和荟萃分析报告了具有统计学意义的关联，这导致许多中心在输血期间采取了在围输血期停止肠内喂养的做法，以预防NEC；然而，最近的研究结果并不支持这种关联的存在，因此对这种做法改变的有效性提出了质疑。
本研究旨在进行系统评价和荟萃分析，以确定近期接受PRBC输血（定义为48小时内）是否与婴儿随后发生≥II期NEC（贝尔标准）有关。
检索了从创刊至2015年10月7日的Medline、Embase、CINAHL和Cochrane图书馆。还进行了灰色文献检索。纳入比较近期接受和未接受PRBC输血的婴儿发生NEC风险的研究。13项研究符合纳入标准，10项研究（n = 15675名婴儿）纳入荟萃分析。三位作者独立提取数据，并使用随机效应模型进行荟萃分析。
我们发现，近期接受PRBC输血的婴儿未经调整的NEC发生几率在统计学上显著降低了45%（比值比 = 0.55，95%置信区间 = 0.31 - 0.98）。
我们的结果显示近期PRBC输血对随后发生NEC具有保护作用。鉴于这些结果，应重新评估围输血期停止肠内喂养的做法。
