Transfusion practices in very low birth weight neonates and the development of necrotising enterocolitis in two neonatal units in Bloemfontein, Free State
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Date
2020-07
Authors
Kruger, I.
Journal Title
Journal ISSN
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Publisher
University of the Free State
Abstract
Background: Necrotising enterocolitis (NEC) places a massive burden on neonatal units and the healthcare system. Not only does it significantly prolong the hospital stay of neonates, it also causes detrimental long-term sequelae, such as neurodevelopmental delay, growth retardation and chronic gastrointestinal complications. However, despite it being a well-documented disease, with the first reports of clinical findings indicative of NEC being made as early as the early 1800’s, it continues to elude neonatologists in terms of risk factors, prevention and treatment strategies. Further research is necessary to help identify possible contributing factors, to improve treatment, as well as to develop preventative strategies for this difficult condition. One possible contributing factor that has been identified by researchers, is the transfusion of blood products in the neonatal period, especially in preterm neonates. Since there are currently no standardised Red Blood Cell (RBC) transfusion protocols in either of the two Neonatal Intensive Care Units (NICU’s) in Pelonomi Tertiary Hospital (PTH), and Universitas Academic Hospital (UAH), patients receive RBC transfusions at a great variety of different clinical stages. Objectives: By retrospectively evaluating the RBC transfusion practices in these units, specifically in those patients who developed NEC, we hoped to gain better insight into the possible causative relationship between RBC transfusions, and the development of NEC in Very Low Birth Weight (VLBW) neonates. Method: Data was collected on a total of 1585 VLBW neonates who were treated at PTH, and UAH, during a retrospective 5-year period. Data collected included gestational age, birth weight, RBC transfusion data, and data regarding the development of NEC. The RBC transfusion data included their pre-transfusion haematocrit, post-transfusion haematocrit, recorded clinical state during transfusion, ventilatory state during transfusion, and whether they were kept nil per os (NPO) during, and for at least 120minutes after the transfusion. Regarding NEC: for all VLBW neonates who developed NEC the following data was recorded: The Modified Bell’s Staging grade, whether they developed NEC before an RBC transfusion, or within 48-hours after an RBC transfusion. Results: This study showed that the incidence of NEC in VLBW neonates in these two academic hospitals was higher than the expected international number. There was a definite decrease in the number of VLBW neonates who received RBC transfusions over the 5-year period, with an improvement in feeding practices during transfusions. This decrease in RBC transfusions correlated with a decrease in the incidence of Transfusion Associate Necrotising Enterocolitis (TANEC), but no statistical significance between feeding practices during RBC transfusion and the development of TANEC, could be demonstrated.
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Keywords
Dissertation (M.Med (Paediatric Surgery))--University of the Free State, 2020, Necrotising enterocolitis (NEC), Chronic gastrointestinal complications, Red Blood Cell (RBC) transfusion