Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, ON, Canada. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Journal of Perinatal Medicine. 2017;46((6):):665-676
CONTEXT 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. OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSION 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.
Additional Material
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Erroneous conclusion due to mis-calculation of data: reply to Rai SE, Sidhu AK, Krishnan RJ. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis. J Perinat Med 2017 <a href="https://www.degruyter.com/view/j/jpme.ahead-of-print/jpm-2017-0370/jpm-2017-0370.xml?intcmp=trendmd;">https://www.degruyter.com/view/j/jpme.ahead-of-print/jpm-2017-0370/jpm-2017-0370.xml?intcmp=trendmd;</a> Letter to the Editor by Stritzke A and Shah PS. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis <a href="https://www.degruyter.com/view/j/jpme.ahead-of-print/jpm-2018-0164/jpm-2018-0164.xml?format=INT&intcmp=trendmd">https://www.degruyter.com/view/j/jpme.ahead-of-print/jpm-2018-0164/jpm-2018-0164.xml?format=INT&intcmp=trendmd</a>
Credits
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Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
