Transfusion-Related Necrotizing Enterocolitis
Mallard, Ellen
Problem: Transfusion-related NEC (TR-NEC) leads to increased morbidity and mortality numbers within the very low birth weight (VLBW) population, and remains a challenge as its complex, multifactorial etiology is not well understood. Infants weighing less than 1500 grams are considered VLBW. Packed red blood cell (RBC) transfusions are a common treatment for anemia in the VLBW population. This project attempts to investigate the occurrence of this phenomenon in three NICUs located in the Midwest, identify possible contributing factors, and present the outcomes of the retrospective chart reviews in a descriptive manner.
Methods: The Neuman Systems Model nursing theory was applied as a framework for review. A retrospective chart review of all VLBW infants diagnosed with necrotizing enterocolitis over the past two years was collected. The information gathered about each study subject included: gestational age at birth, weight at birth, feeding orders, hematocrit levels, and respiratory support at time of diagnosis.
Results: Of the 22 subjects studied, the lowest gestational age infant at birth was 23 1/7 weeks and the lowest birth weight was 430 grams. The highest gestational age infant at birth was 32 4/7 weeks, and the highest birth weight was 3040 grams. The shortest time from birth to developing necrotizing TR-NEC was 4 days, and the longest time from birth to developing TR-NEC was 67 days. The hematocrit levels ranged from 18.9% to 35.6%.
Conclusions: The results obtained from this study correlated to the current literature on the factors associated with the development of TR-NEC. The highest risk population remains the VLBW infants born between 23 and 25 weeks gestation, who receive a (RBC) transfusion after day 7 and before day 30 of life. More than half of the subjects at time of transfusion were on conventional or high frequency ventilation. The results of this study did not correlate to the literature in regards to the type of feedings. Mother’s breast milk fed babies were not at a lower risk of developing TR-NEC.