• Beena G Sood, Anupama Rambhatla, Ronald Thomas, and Xinguang Chen.
• a Division of Neonatal-Perinatal Medicine , Hutzel Women's Hospital & Children's Hospital of Michigan , Detroit , MI , USA .
• J. Matern. Fetal. Neonatal. Med. 2016 Mar 1; 29 (5): 737-44.

Background And ObjectivesMany observational studies reporting a temporal association between red cell transfusions (RBCTs) and necrotizing enterocolitis (NEC) in preterm infants fail to take into account RBCTs in infants without NEC. The objective of this study was to investigate the association between RBCTs and NEC in an analytical retrospective cohort study with minimization of selection and measurement bias and controlling for clinical covariates.MethodsInborn preterm infants [23-32 weeks gestational age (GA)] without major congenital anomalies were eligible. Association of RBCT and modified Bell's Stage ≥2A NEC was explored using bivariate analyses and verified using multivariable Cox regression.ResultsOf 627 eligible infants, 305 neither received RBCT nor developed NEC and 12 developed NEC prior to RBCT. Of 310 infants with RBCT, 27 developed NEC. Compared to infants without NEC, infants with NEC received significantly lower number of RBCTs before diagnosis of NEC (p = 0.000). On multivariable Cox regression controlling for clinical covariates, dichotomous RBCT exposure was associated with 60% reduced hazard for NEC.ConclusionsRBCT exposure was associated with decreased hazards for NEC in preterm infants in this study; factors previously reported to be associated with NEC remained statistically significant predictors.

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