1. Transfusion-Related Necrotizing Enterocolitis- A Retrospective Review Diane Farley, RN, BSN, Ellen Mallard RNC, BSN & Christy Wood, RN, BSN
RESULTS
Mean gestational age at birth = 26 weeks
Average birth weight = 893 grams
Mean day of life at time of diagnosis = 16 days
32% NPO at time of transfusion
Of those fed, 73% were receiving breastmilk & 27% were receiving formula
64% Invasive ventilatory support at time of diagnosis
35% Non-invasive respiratory support, including CPAP, HFNC, and NIV
Hematocrit levels varied, lowest = 18%, highest = 35.6%.
PURPOSE
To determine if there is a specific variable associated with the development of transfusion -related necrotizing enterocolitis (TR-NEC) in the premature neonate receiving red blood cell (RBC) transfusions. The aims are to examine the clinical criteria for transfusions, enteral feeding during time of transfusion, and the subsequent development of NEC via retrospective chart review of neonatal intensive care unit (NICU) subjects.
METHODOLOGY
Retrospective chart review
Inclusion criteria: Infants diagnosed with NEC within 72 hours of RBC transfusion
Exclusion criteria: Infants admitted with diagnosis of NEC and full access to previous records was not available
n = 22 infants
Descriptive data was obtained and explored
PROBLEM
Over half of the premature population will require a blood transfusion during NICU hospitalization, with some resulting in NEC, the most common gastrointestinal emergency affecting very-low-birthweight (VLBW) infants
El-Dib (2011) indicates mortality rates associated with NEC range from 15% to 30% and increases further for infants requiring surgical interventions, such as drain placement or bowel resections
Complications from NEC can have devastating long-term effects for infants who survive
LITERATURE REVIEW
Current studies cite the most influential risk factors in the development of TR-NEC are extreme prematurity and VLBW
Stritzke (2013) reported NEC onset at day of life 20 and mean gestational age of 28.8 weeks in a multi-year large scale Canadian study
El-Dib, Narang, Lee, Massaro, and Aly (2011) found holding feedings during transfusions reduced the incidence of developing NEC from 5% to 1%
Marin (2013) showed decreased tissue perfusion and instability of the gut mucosa during and just after an RBC transfusion
DISCUSSION
Literature review and study results concurred on the following factors:
Contributing risk factors include extreme prematurity and VLBW
Majority of patients diagnosed with TR-NEC were receiving enteral feedings
Additional information obtained from the study:
Transfusion guidelines varied among the institutions
Though the majority of patients required assisted ventilation, all modes of respiratory support were represented in the sample