Red blood cell transfusion–related necrotizing enterocolitis in very-low-birthweight infants: a near-infrared spectroscopy investigation

Authors

  • Terri Marin,

    Corresponding author
    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    • Address correspondence to: Terri Marin, Office 344, 1520 Clifton Road Northeast, Atlanta, GA 30322; e-mail: tmarin@emory.edu.

    Search for more papers by this author
  • James Moore,

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author
  • Niki Kosmetatos,

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author
  • John D. Roback,

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author
  • Paul Weiss,

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author
  • Melinda Higgins,

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author
  • Linda McCauley,

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author
  • Ora L. Strickland,

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author
  • Cassandra D. Josephson

    1. Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia
    2. Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia
    3. Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas
    4. Rollins School of Public Health, Emory University, Atlanta, Georgia
    5. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
    6. School of Nursing, Florida International University, Miami, Florida
    7. Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia
    Search for more papers by this author

  • The manuscript is supported in part by National Institute of Health Pediatric Transfusion Medicine Academic Career Award HL086773-01, the Florida Association of Neonatal Nurse Practitioners, and Sigma Theta Tau International Honor Society of Nursing.

Abstract

Background

Recent evidence suggests that antecedent red blood cell (RBC) transfusions increase the risk for necrotizing enterocolitis (NEC), the most common gastrointestinal emergency encountered by very-low-birthweight (VLBW) infants. The underlying mechanism for this association is unknown. Altered oxygenation of the mesenteric vasculature during RBC transfusion has been hypothesized to contribute to NEC development and was investigated in this study.

Study Design and Methods

Oxygenation patterns among four VLBW infants who developed transfusion-related NEC (TR-NEC) were compared to four VLBW infants with similar gestational age who were transfused but did not develop NEC (non-NEC). Cerebral and mesenteric patterns were recorded before, during, and 48 hours after RBC transfusion using near-infrared spectroscopy (NIRS) technology. Percentage change from mean baseline regional oxygen saturation values and cerebrosplanchnic oxygenation ratios were analyzed.

Results

All TR-NEC infants (24-29 weeks’ gestation; 705-1080 g) demonstrated greater variation in mesenteric oxygenation patterns surrounding transfusions than non-NEC infants (27.6-30 weeks’ gestation; 980-1210 g). TR-NEC infants received larger mean volumes of total blood (27.75 ± 8.77 mL/kg) than non-NEC infants (15.25 ± 0.5 mL/kg).

Conclusion

Wide fluctuation and decreases in mesenteric oxygenation patterns are more pronounced in TR-NEC infants, especially before TR-NEC onset, compared to non-NEC infants. Greater total volume of infused blood was associated with TR-NEC in preterm infants. Using NIRS, larger prospective studies are needed to further evaluate potential risk factors for NEC in this high-risk population.

Ancillary