University of Illinois College of Medicine Peoria, United States
Background/Case Studies: Necrotizing Enterocolitis (NEC) is a significant cause of morbidity and mortality in very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU). Much of the literature on NEC and transfusion, focuses on whether transfusion is a risk factor for NEC. However, NEC can present with bleeding and coagulopathy in severe cases.
Limited data exist regarding the need for transfusion and coagulation testing afterthe NEC diagnosis to support these patients. To study the characteristics of very low birth weight (< 1500g) infants with ≥ Bell stage II NEC requiring transfusion of blood products within the first 72 hours of diagnosis.
Study
Design/Methods: We performed a retrospective review of VLBW neonates in our level IV academic center NICU who received blood transfusions between February 2018 and August 2024. Each patient’s chart was reviewed to determine if a diagnosis of NEC had been made during their hospitalization. Variables collected for each patient were gestational age (GA), birth weight (BW), NEC stage, age at diagnosis in days of life (DOL), type of transfusion, time of transfusion from NEC diagnosis and survival. Patients who received transfusion within 72 hours after NEC (NEC+ TXN) were compared with those who did not receive transfusion during that initial 72-hour period after NEC diagnosis (NEC).
Results/Findings: Out of 672 VLBW infants; 185 were transfused during their NICU stay. Total 24 VLBW infants were diagnosed with stage II/III NEC during this period while 10 infants were NEC +TXN and the other 14 patients were NEC. There were no differences in GA, BW, DOL, stage or survival between the NEC+ TXN and NEC groups.
Of the 10 patients transfused, 50% received only red blood cells and 50% received a combination of red cells, plasma/cryoprecipitate and/or platelets. 20% (2/10) patients received all 4 blood products. (Figure 1). Within 72 hours of diagnosis, complete blood count (CBC) testing was performed in 21/24 (87%) and 42% (9/21) of these patients received RBC and/or platelets. Coagulation testing was performed only in 10/24 (41%) and 50%(5/10) of these patients received FFP, Cryo or both.
Conclusions: In our cohort of transfused neonates with NEC, a significant number required complex transfusion with multiple products in addition to red blood cells within the first few days of their diagnosis. Infants with NEC who did not receive any transfusions during their hospital stay were not included in this study, but will be included in future analysis. Testing for coagulopathy is currently not a standard of care with a NEC diagnosis. Further data is needed to understand how to evaluate and transfuse these patients during the critical days of their initial NEC diagnosis.
