Red blood cell transfusion, intravenous immunoglobulin and NEC : does the association exist?

BACKGROUND: Some studies suggest the association between NEC and RBC transfusion. A correlation between NEC and Ig infusion in newborns with hemolytic disease has been described. OBJECTIVE: This study wants to demonstrate a correlation between RBC transfusion or Ig infusion and NEC, identifying different populations of newborns. DESIGN/METHODS: We reviewed the electronic medical records of 30 cases of NEC admitted to our NICU. We compared age-matched patients (pts) who developed NEC within 72 h after a RBC transfusion (NRT) or Ig infusion with patients that developed NEC unrelated to blood products transfusion (NUT). Statistical analysis was performed using Student's T-test; statistical significance was set as p-values of less than 0.05. RESULTS: We recorded 30 NEC. 16,7% (5) were related to RBC transfusion. The transfusion was performed 23,06 ± 22,87 h before the onset of symptoms, with a mean hematocrit of 30,06 ± 4,64 %. The average GA in the NRT group was 25 ± 1 weeks, compared to 33 ± 3 weeks (p < 0,00001) in the NUT group. The mean BW was 666 ± 195 g, and 1762 ± 536 g (p < 0,00001) in the NRT and NUT group, respectively. The mean age at onset was 24,8 ± 14 d in the NRT group versus 14,2 ± 11 in the NUT group (p = 0,03). 40% of pts in the NRT required surgery versus 16% in the NUT group. The second aim of the study tried to identify a population that developed NEC in the 72 h after Ig infusion. Ig infusion was performed in 3 pts (10%) 47,5 ± 9,26 h before diagnosis. The average GA in NEC-related Ig group (NRI) was 26 ± 2,65 weeks, compared to 32,07 ± 3,68 (p = 0,019) of the NEC unrelated Ig (NUI). The mean BW of NRI group was 800 ± 508,62 g, compared to 1665,93 ± 604,97 g (p = 0,040) of the NUI subset. 33,3% of pts in the NRI group underwent surgery versus 18,5% in the NUI group. CONCLUSIONS: Our data suggest that RBC transfusion and Ig infusion are associated with an increased risk of developing NEC. We identified a subset of newborns, with lower BW and earlier GA at birth, that developed NEC after RBC transfusion; they had a later onset and a greater severity of the disease. The percentage of NRT subset is lower than previously reported. NRI group was characterized by a lower GA and BW compared to the NUI group, without differences in terms of age at onset. This is the first report that underlines a correlation between Ig infusion and NEC in preterms.