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.
Financial disclosure: The authors have no financial relationships relevant to this article to disclose.
Funding source: This project did not receive funding support.
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
Stientje Esther Rai: Dr. Rai conceptualized and designed the study, designed and completed the literature search, extracted the data, assisted in data analysis, interpreted results, drafted the initial manuscript, and approved the final manuscript as submitted.
Amneet Kaur Sidhu: Dr. Sidhu participated in the concept and design of the study, completed the literature search, extracted the data, participated in data analysis and interpretation of results, reviewed and revised the manuscript, and approved the final manuscript as submitted.
Rohin Jayaram Krishnan: Mr. Krishnan participated in the concept and design of the study, extracted the data, performed all statistical analyses, interpreted results, reviewed and revised the manuscript, and approved the final manuscript as submitted.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2017-0048).
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