Necrotizing enterocolitis and mortality after transfusion of ABO non-identical blood

Michael K Parvizian; Rebecca Barty; Nancy M Heddle; Na Li; Tara McDougall; Amit Mukerji; Christoph Fusch; Ziad Solh

doi:10.1111/trf.16638

Necrotizing enterocolitis and mortality after transfusion of ABO non-identical blood

Transfusion. 2021 Nov;61(11):3094-3103. doi: 10.1111/trf.16638. Epub 2021 Sep 6.

Authors

Michael K Parvizian¹, Rebecca Barty², Nancy M Heddle^{1

2}, Na Li^{2

3}, Tara McDougall², Amit Mukerji⁴, Christoph Fusch^{4

5}, Ziad Solh^{6

7}

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
² McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical School, Nuremberg, Germany.
⁶ Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine (PaLM), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
⁷ Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

PMID: 34487551
DOI: 10.1111/trf.16638

Abstract

Background: The relationship between ABO non-identical transfusion and the outcomes of necrotizing enterocolitis (NEC), and all-cause mortality in very-low birth weight (VLBW) neonates receiving red blood cell transfusion is unknown.

Study design and methods: A retrospective multicenter cohort study was conducted in VLBW neonates in neonatal intensive care units between 2004 and 2016. VLBW (≤1500 grams) neonates were followed until discharge or in-hospital death. The primary exposure was ABO group. Secondary exposures included platelet count, plasma transfusions, and maternal ABO group. Outcome measures were NEC (defined as Bell stage ≥ 2) and all-cause mortality. Time-dependent Cox regression models with competing risks were used to investigate factors associated with NEC and mortality.

Results: Thousand and sixteen neonates were included with 10.8% developing NEC (n = 110) and 14.1% mortality (n = 143). Platelet count (hazard ratio [HR] = 0.995; 95% confidence interval [CI]: 0.922-0.998) and number of plasma transfusions (HR = 2.908; 95% CI:1.265-6.682) were associated with NEC, while ABO group (non-O vs. O) was not (HR = 0.761; 95% CI: 0.393-1.471). Higher all-cause mortality occurred in neonates without NEC who were non-O compared with O (HR = 17.5; 95% CI: 1.784-171.692), but not in neonates with NEC (HR = 1.112; 95% CI: 0.142-8.841). Plasma transfusion was associated with increased mortality in both groups.

Discussion: ABO non-identical transfusion was not associated with NEC or mortality in neonates with NEC. It was associated with increased mortality in neonates without NEC. As many neonatal intensive care units transfuse only O group blood as routine practice, future trials are needed to investigate the association between this practice and neonatal mortality.

Keywords: ABO blood group; blood transfusion; necrotizing enterocolitis; neonatology.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Blood Component Transfusion / adverse effects
Cohort Studies
Enterocolitis, Necrotizing* / etiology
Gestational Age
Hospital Mortality
Humans
Infant, Newborn
Infant, Newborn, Diseases*
Infant, Very Low Birth Weight
Plasma
Retrospective Studies
Risk Factors