The relationship of red blood cell transfusion to intestinal mucosal injury in premature infants

Objective To determine the incidence of intestinal mucosal injury before and after transfusions in premature infants. Study design Urine was collected throughout the hospital stay of 62 premature infants and specimens obtained within 24 h before and after transfusion were assayed for intestinal fatty acid binding protein (iFABP). A urinary iFABP:creatinine ratio (iFABPu:Cru) of 2.0 pg/nmol was considered elevated. Result Forty-nine infants were transfused. iFABPu:Cru was elevated following 71 (75.6%) of 94 transfusions for which urine was available. In 51 (71.8%) of these, iFABPu:Cru was also elevated prior to the transfusion. Among four cases of transfusion-associated NEC, iFABPu was elevated following every sentinel transfusion and prior to three of them. Conclusion Subclinical intestinal mucosal injury is frequent following blood transfusions in premature infants and, when present, usually precedes transfusion. This suggests that transfusion may not be a primary mediator of intestinal injury so much as anemia and its associated conditions. Level of evidence Prognosis study/level 3