Ravi Mangal Patel, MD, MSc and Eric Gibson, MD
There is conflicting data regarding the role of red blood cell transfusions and anemia on the development of NEC. Further studies are needed to evaluate whether preventing severe anemia is more important than minimizing RBC transfusion.
Necrotizing enterocolitis (NEC) is a leading cause of death among extremely premature infants and has a high rate of mortality. Multiple clinical studies have identified a temporal association between red blood cell (RBC) transfusions and NEC. Data from recent meta-analyses and randomized trials is currently insufficient to suggest that RBC transfusions alone cause NEC. Dr. Patel presents evidence to advocate for the role of anemia prior to transfusion as a cause of NEC rather than the act of transfusion alone. Anemia can impair gut perfusion resulting in tissue hypoxia and can predispose to ischemic injury and possibly NEC. Further research is needed to determine how oxygen delivery actually impacts the neonatal gut and to understand the potential interaction between anemia and RBC transfusion on the outcome of NEC.