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American Journal of Epidemiology Vol. 126, No. 6: 1165-1172
Copyright © 1987 by The Johns Hopkins University School of Hygiene and Public Health

research-article

AN OUTBREAK OF NECROTIZING ENTEROCOLITIS

ASSOCIATION WITH TRANSFUSIONS OF PACKED RED BLOOD CELLS

GENE A. McGRADY1,, PHILIP J. RETTING2, GREGORY R ISTRE3, JANINE M. JASON1, ROBERT C HOLMAN1 and BRUCE L. EVATI1

1Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control Atlanta, GA
2Division of Infectious Disease, Department of Pediatrics, College of Medicine, University of Oklahoma Oklahoma City, OK
3Epidemiology Service, Division of Epidemiology, State Department of Health Oklahoma City, OK

Reprint requests to Dr. Gene A. McGrady, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Weetview Drive, S.W., Atlanta, GA 30310-1495

Of 187 newborns admitted to a 33-bed, level III neonatal intensive care unit between January 1, 1985 and June 23, 1985, 33 developed necrotlzlng enterocolitis during their hospital stay. Twenty of the 33 newborns (61%) had onset of symptoms between April 1 and June 23, suggesting clustering during this period. A case-control study, with matching on birth weIght class, approximate date of admission to the unit and approximate duration of stay, failed to reveal any association of the syndrome with type or timing of feeding, perinatal hypoxic events, as determined by apgar scores and labor history, or specific microbial organisms. By contrast, however, transfusion of packed red blood cells was highly and significantly associated with the syndrome (odds ratio = 15.1, 95% confidence interval = 2.59–92.51). In addition, therapy with caffeine, with theoph ylline, and with furosemide were moderately associated with the syndrome, although not significantly so. During this outbreak period, the Incidence of necrotizing enterocolitis by birth weight was 30.6% in infants less than 1,500 gm, 10.8% in infants 1,500–2,500 gm, and 11.9% in infants 2,500 gm or more. These findings confirm the importance of low birth weight as a risk factor for development of the syndrome and suggest that Insults to volume homeostasis, such as transfusion and use of diuretics, need to be considered as possible mechanisms whereby necrotizing enterocolitis is Initiated.

blood transfusion; disease outbreaks; diuretics; enterocolitis, necrotizing; Infant, premature; space-time clustering


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