Necrotizing enterocolitis and blood transfusion: how are they related?
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Abstract
Introduction: the necrotizing enterocolitis is a multifatorial pediatric emergency and there is controversy regarding the role of blood transfusions in its development. Objective: our objective was to describe two cases in which a consistent temporal relationship between transfusions and the disease development was observed, in other words, up to 48 hours after a transfusion. Case description: in our two cases, the neonates had low hemoglobin levels and developed necrotizing enterocolitis between 5 to 12 hours after the blood transfusion. The neonate 1 presented abdominal distension and shock signs, about five hours after the transfusion. Abdominal radiography evidenced loop distension, some suggestive areas of intestinal pneumatosis and fixed loops. This neonate underwent a diagnostic laparotomy. The neonate 2, about eight hours after the transfusion, presented significant abdominal distension and developed sudden and severe shock. The radiography showed intestinal pneumatosis. Discussion: There is controversy in whether the pre-established anemia or the transfusion are elements of the pathogenesis of necrotizing enterocolitis or whether they are markers of the imminent disease. Our case reports suggest that high risk neonates should be strictly observed in the first 48 hours after blood transfusion, to detect early signs of disease and to start treatment immediately, despite the actual pathogenesis of
necrotizing enterocolitis.
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