<strong>Introduction:</strong> <span style="font-family:Verdana;">Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies...<strong>Introduction:</strong> <span style="font-family:Verdana;">Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies who are born at term. Complications related to prematurity increase as gestational age decreases and anemia is one of the complications of prematurity which needs packed cell transfusions. To date, when to transfuse preterm babies and what would be the threshold for hemoglobin and hematocrit is still a point of argument as well as liberal versus restrictive transfusion protocols have been developed but what should be followed still needs more data. In our study, we have observed frequencies of different indications of packed cell transfusion in the neonatal intensive care unit of a tertiary care hospital. This endeavor will help in the establishment of guidelines regarding transfusion and the threshold on which any intervention should be done also it would be a step towards the identification of preventable causes that lead to transfusion and transfusion-related risks and hazards.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Objective:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">To determine the indication of packed cell transfusion and their frequencies in preterm neonates.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Design:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">This was a cross-sectional study.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Setting:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The study was carried out in the neonatal intensive care unit (NICU).</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Duration:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The duration of the study was 1 year.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Material and Methods:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">A total of 246 preterm neonates admitted to Aga Khan University Hospital (AKUH) neonatal intensive care unit in the tenure of 1 year, fulfilling the inclusion criteria and requiring packed cell transfusion were included. After the approval from ethical review committee, charts were reviewed for gestational age, birth weight, mode of delivery (normal vaginal or Cesarean-section) were recorded. Indications of packed cell transfusion (intraventricular hemorrhage, infection or sepsis, anemia of prematurity, phlebotomy losses, increase oxygen requirement, hematological causes, other causes of hemorrhage and other causes) were observed and recorded. Pre-transfusion hemoglobin levels (g/dL) and hematocrit levels were also recorded. Other information like number and volume of transfusion and day of life on which transfusion was administered was also documented.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:""> </span></b><span style="font-family:""><span style="font-family:Verdana;">A total of 246 critically ill children were enrolled in this study. Of t</span><span style="font-family:Verdana;">he total, 52.8% were baby boys and 47.2% were baby girls. 57% of babies were born via cesarean section and 43% were born via vaginal delivery. Out of total preterm newborns admitted in NICU, 22.8% were extremely preterm, 35.4% were very preterm and 41.9% were late preterm. Mean gestational age was observed to be 31 (±4) weeks and the mean birth weight of newborns was 1500 (±600) grams.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">Indications of packed cell transfusion observed in our study are intraventricular hemorrhage 10%, 26% sepsis/infection</span><span style="font-family:Verdana;">, 4% hematological disorders, 12.8% anemia of prematurity, 25.2% was related to increase in oxygen requirement, 13% other hematological causes and 9.3% other causes.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">An increase in oxygen requirement and anemia of prematurity were the indications that were observed in the extremely preterm and very preterm groups. Sepsis and increase oxygen requirement are some of the major causes of transfusions observed in the late preterm group. Preventable indications can be one of the areas that can be worked on and will reduce the need for transfusion in preterm babies with subsequent prevention of transfusion-associated risks.</span>展开更多
The bioactivities of culture supernatants from retroviral packaging cells carrying the mouse Fas ligand (mFasL) gene was investigated. FasLcDNA was cloned into PLXIN with an internal ribosome entry site to link two ci...The bioactivities of culture supernatants from retroviral packaging cells carrying the mouse Fas ligand (mFasL) gene was investigated. FasLcDNA was cloned into PLXIN with an internal ribosome entry site to link two cistrons through gene recombination technology, PLXIN and the recombinant vector PLFIN were separately transfected into PA317 retrovirus packing cell line by lipofectamine 2000, and the resistant clones were selected with G418 selective medium. The integration of genome DNA was assayed by genomic DNA PCR. NIH3T3 cells were transduced by the culture supernatants from PA317 carrying the mFasLcDNA gene, and were selected with G418 selective medium, so as to select the PLFIN-PA317 clone capable of producing higher titer of supernatants. The levels of mFasL protein on NIH3T3 cells membrane were assayed by flow cytometry (FCM). The biological activity of mFasL on NIH3T3 cells membrane was investigated by the inducing apoptosis of Fas + Yac-1 cells co-cultured with NIH3T3 cells expressing Fas ligand. To explore the direct mFasL cytotoxicity of culture supernatants from retroviral packaging cells carrying the mFasL gene, the culture supernatants from PLFIN-PA317 and PLXIN-PA317 were separately co-cultured with Yac-1 cells in parallel. The recombinant PLFIN was successfully constructed. The highest titer of supernatants from twelve resistant clones was 8.5×10 5 colony-forming-unit (CFU)/ml. The NIH3T3 cells transfected by above supernatants had a higher level of mFasL (53.81±6.9 %), and significantly induced the apoptosis of Fas + Yac-1 cells (56.78±4.5 %), as both were cocultured for 5 h at 1∶1 ratio, whereas it is 7.08±3.4 % in control group (P<0.01). Supernatant from PLFIN-PA317 could also directly induce the apoptosis of Yac-1 within 5 h of incubation. Thus, the culture supernatants from PLFIN-PA317 possessed both infectivity and cytotoxicity of mFasL.展开更多
Background:The effects of packed red blood cell(PRBC)transfusion on the prognosis of patients with upper gastrointestinal bleeding(UGIB),particularly on the 30-day mortality rate,are unclear.This study aimed to determ...Background:The effects of packed red blood cell(PRBC)transfusion on the prognosis of patients with upper gastrointestinal bleeding(UGIB),particularly on the 30-day mortality rate,are unclear.This study aimed to determine the prognostic influence of PRBC transfusion in patients with UGIB with different hemoglobin(Hb)levels.Methods:The subjects in this study were selected from the Philips Electronic ICU Collaborative Research Database Version 2.0 multi-center critically ill patient database from January 2014 to December 2015.A total of 4689 patients were included in this study.The Hb levels were divided into 3 groups:Hb<6 g/dL(Group 1),6 g/dL≤Hb<8 g/dL(Group 2),and Hb≥8 g/dL(Group 3).Based on the ad-ministration of PRBC transfusion,each group was subdivided into PRBC and non-PRBC groups.Results:A total of 4689 patients were enrolled in the study,including 825,2195,and 1669 patients in Groups 1,2,and 3,respectively.Furthermore,the PRBC and non-PRBC groups consisted of 1847 and 2842 patients,respectively.There was no significant difference in the 30-day mortality rate between Group 1 and Group 2 or between the PRBC and non-PRBC subgroups.In Group 3,the 30-day mor-tality rate of patients who received transfusion was higher than that of patients who did not(13.29%vs 9.14%,P=0.029).For the PRBC group,the difference in 30-day mortality rate was not statistically significant among the 3 groups,whereas for the non-PRBC group,the 30-day mortality rate in Group 3 was the lowest,and there was a significant difference among the 3 groups(P=0.003).There was no significant difference in the subgroup analysis of bleeding at different sites and etiologies.Conclusion:Packed red blood cell transfusion does not improve prognosis or reduce mortality in patients with UGIB but may increase mortality in patients with Hb levels greater than 8 g/dL.展开更多
The rice field frog Hoplobatrachus rugulosus is an important anuran species found in wetlands throughout Thailand. At present, the hematological parameters of wild populations are unknown. Therefore, hematological and...The rice field frog Hoplobatrachus rugulosus is an important anuran species found in wetlands throughout Thailand. At present, the hematological parameters of wild populations are unknown. Therefore, hematological and morphological characteristics of peripheral blood cells of wild-caught H. rugulosus were examined. Thirty-three adult frogs (17 male and 16 female frogs) were collected from a natural population in Nan Province, northem Thailand during the wet season of 2014. Blood samples were analyzed by packed cell volume (PCV) and blood cell counts from hemocytometer and Giemsa-stained blood smears. The mean PCV of male frogs (30.70% ±6.07%) was significantly higher than that of the female frogs (25.09%± 4.85%). The mean number of lymphocytes and neutrophils also showed significant sex-related differences. Moreover, the morphometric analysis of blood cells revealed dimensions as follows: erythrocytes (17.96 ±1.44 μm length × 11.50 ± 1.09μm width), immature erythrocytes (14.91 ± 2.20 μm diameter), thrombocytes (13.93± 3.14 μm length × 7.05 ± 1.31 μm width), lymphocytes (11.01 ±2.69μm diameter), monocytes (12.04±2.40 μm diameter), neutrophils (12.58 -±2.08μm diameter), basophils (13.60 ± 2.17μm diameter) and eosinophils (12.33 ± 2.95 μm diameter). Overall, the hematological parameters obtained in this study could be regarded as the first report and a crucial baseline data of wild H. rugulosus in Thailand that can be used for monitoring the health status of this anuran.展开更多
<strong>Background: </strong>The December 2019 Chinese epidemic of Corona Virus Disease [COVID-19], which erupted in Wuhan, South China, was declared a pandemic, by the World Health Organization [WHO], on ...<strong>Background: </strong>The December 2019 Chinese epidemic of Corona Virus Disease [COVID-19], which erupted in Wuhan, South China, was declared a pandemic, by the World Health Organization [WHO], on 12<sup>th</sup> January 2020. The worldwide spread from China was rapid, but Africa was the last port-of-call. Her first diagnosed case was two months after China’s, on 14<sup>th</sup> February, 2020 in Egypt. The morbidity and mortality rates have, however, remained lower in Africa than in the developed world, and analysts believe that it was more of a temporary respite, since Africa’s poor health infrastructure will become her eventual albatross. <strong>Methodology:</strong> Data were collected on COVID-19 and records of the socio-economic capacity of Africa by accessing the relevant previous and current peer-reviewed publications from multiple search engines on internet. The data were, then, collated and comparatively analyzed. <strong>Results: </strong>The available data revealed that Africa had, mostly, the milder forms of COVID-19, and so, morbidity and mortality were low. Her shrinking elderly population and hot climate were believed to be contributory, but lately, as the pandemic spread, the role of these factors was not exactly predictive. Being low on healthcare infrastructure, Africa could tenaciously leverage on the supportive and preventive measures prescribed by WHO, while the world awaited a vaccine. The role of ventilators in the care of critically ill patients, also, came under scrutiny as some workers were questioning the underlying pathology, and advocating a paradigm shift from high-tech positive end expiratory pressure ventilation to plasmapheresis and packed cell transfusion. <strong>Conclusion:</strong> Africa faces a huge challenge with COVID-19, but the predicted heavy mortalities may be reduced by some local confounding factors, control of spread and re-focusing of critical care away from the expensive and unavailable ventilators.展开更多
Background Prior studies report conflicting evidence on the association between packed red blood cell(PRBC)transfu-sions and necrotizing enterocolitis(NEC),especially in early weeks of life where transfusions are freq...Background Prior studies report conflicting evidence on the association between packed red blood cell(PRBC)transfu-sions and necrotizing enterocolitis(NEC),especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC.The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life(DOL)14 in very premature neonates.Methods A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14.Primary endpoints were PRBC transfusions after DOL 14 until the date of NEC diagnosis,discharge,or death.Wilcoxon ranked-sum and Fisher's exact tests,Cox proportional hazards regression,and Kaplan-Meier curves were used to analyze data.Results Of 549 premature neonates,186(34%)received transfusions after DOL 14 and nine(2%)developed NEC(median DOL=38;interquartile range=32-46).Of the nine with NEC after DOL 14,all were previously transfused(P<0.001);therefore,hazard of NEC could not be estimated.Post hoc analysis of patients from DOL 10 onward included five additional patients who developed NEC between DOL 10 and DOL 14,and the hazard of NEC increased by a factor of nearly six after PRBC transfusion(hazard ratio=5.76,95%confidence interval=1.02-32.7;P=0.048).Conclusions Transfusions were strongly associated with NEC after DOL 14.Prospective studies are needed to determine if restrictive transfusion practices can decrease incidence of NEC after DOL 14.展开更多
文摘<strong>Introduction:</strong> <span style="font-family:Verdana;">Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies who are born at term. Complications related to prematurity increase as gestational age decreases and anemia is one of the complications of prematurity which needs packed cell transfusions. To date, when to transfuse preterm babies and what would be the threshold for hemoglobin and hematocrit is still a point of argument as well as liberal versus restrictive transfusion protocols have been developed but what should be followed still needs more data. In our study, we have observed frequencies of different indications of packed cell transfusion in the neonatal intensive care unit of a tertiary care hospital. This endeavor will help in the establishment of guidelines regarding transfusion and the threshold on which any intervention should be done also it would be a step towards the identification of preventable causes that lead to transfusion and transfusion-related risks and hazards.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Objective:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">To determine the indication of packed cell transfusion and their frequencies in preterm neonates.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Design:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">This was a cross-sectional study.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Setting:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The study was carried out in the neonatal intensive care unit (NICU).</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Duration:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The duration of the study was 1 year.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Material and Methods:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">A total of 246 preterm neonates admitted to Aga Khan University Hospital (AKUH) neonatal intensive care unit in the tenure of 1 year, fulfilling the inclusion criteria and requiring packed cell transfusion were included. After the approval from ethical review committee, charts were reviewed for gestational age, birth weight, mode of delivery (normal vaginal or Cesarean-section) were recorded. Indications of packed cell transfusion (intraventricular hemorrhage, infection or sepsis, anemia of prematurity, phlebotomy losses, increase oxygen requirement, hematological causes, other causes of hemorrhage and other causes) were observed and recorded. Pre-transfusion hemoglobin levels (g/dL) and hematocrit levels were also recorded. Other information like number and volume of transfusion and day of life on which transfusion was administered was also documented.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:""> </span></b><span style="font-family:""><span style="font-family:Verdana;">A total of 246 critically ill children were enrolled in this study. Of t</span><span style="font-family:Verdana;">he total, 52.8% were baby boys and 47.2% were baby girls. 57% of babies were born via cesarean section and 43% were born via vaginal delivery. Out of total preterm newborns admitted in NICU, 22.8% were extremely preterm, 35.4% were very preterm and 41.9% were late preterm. Mean gestational age was observed to be 31 (±4) weeks and the mean birth weight of newborns was 1500 (±600) grams.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">Indications of packed cell transfusion observed in our study are intraventricular hemorrhage 10%, 26% sepsis/infection</span><span style="font-family:Verdana;">, 4% hematological disorders, 12.8% anemia of prematurity, 25.2% was related to increase in oxygen requirement, 13% other hematological causes and 9.3% other causes.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">An increase in oxygen requirement and anemia of prematurity were the indications that were observed in the extremely preterm and very preterm groups. Sepsis and increase oxygen requirement are some of the major causes of transfusions observed in the late preterm group. Preventable indications can be one of the areas that can be worked on and will reduce the need for transfusion in preterm babies with subsequent prevention of transfusion-associated risks.</span>
基金This project was supported by a grant from National Natural Sciences Foundation of China(No.39770 76 7)
文摘The bioactivities of culture supernatants from retroviral packaging cells carrying the mouse Fas ligand (mFasL) gene was investigated. FasLcDNA was cloned into PLXIN with an internal ribosome entry site to link two cistrons through gene recombination technology, PLXIN and the recombinant vector PLFIN were separately transfected into PA317 retrovirus packing cell line by lipofectamine 2000, and the resistant clones were selected with G418 selective medium. The integration of genome DNA was assayed by genomic DNA PCR. NIH3T3 cells were transduced by the culture supernatants from PA317 carrying the mFasLcDNA gene, and were selected with G418 selective medium, so as to select the PLFIN-PA317 clone capable of producing higher titer of supernatants. The levels of mFasL protein on NIH3T3 cells membrane were assayed by flow cytometry (FCM). The biological activity of mFasL on NIH3T3 cells membrane was investigated by the inducing apoptosis of Fas + Yac-1 cells co-cultured with NIH3T3 cells expressing Fas ligand. To explore the direct mFasL cytotoxicity of culture supernatants from retroviral packaging cells carrying the mFasL gene, the culture supernatants from PLFIN-PA317 and PLXIN-PA317 were separately co-cultured with Yac-1 cells in parallel. The recombinant PLFIN was successfully constructed. The highest titer of supernatants from twelve resistant clones was 8.5×10 5 colony-forming-unit (CFU)/ml. The NIH3T3 cells transfected by above supernatants had a higher level of mFasL (53.81±6.9 %), and significantly induced the apoptosis of Fas + Yac-1 cells (56.78±4.5 %), as both were cocultured for 5 h at 1∶1 ratio, whereas it is 7.08±3.4 % in control group (P<0.01). Supernatant from PLFIN-PA317 could also directly induce the apoptosis of Yac-1 within 5 h of incubation. Thus, the culture supernatants from PLFIN-PA317 possessed both infectivity and cytotoxicity of mFasL.
基金funded by the Top Talent Support Program for young and middle-aged people of the Wuxi Health Committee,Jiangsu Health Emergency Research Institute,Project of Medical Emergency Rescue Research Center of Xuzhou Medical University(JSWSYJ-20210701)Special Project of Jiangsu Hospital Association Hospital Management Innovation Research Fund(JSYGY-2-2021-JZ56).
文摘Background:The effects of packed red blood cell(PRBC)transfusion on the prognosis of patients with upper gastrointestinal bleeding(UGIB),particularly on the 30-day mortality rate,are unclear.This study aimed to determine the prognostic influence of PRBC transfusion in patients with UGIB with different hemoglobin(Hb)levels.Methods:The subjects in this study were selected from the Philips Electronic ICU Collaborative Research Database Version 2.0 multi-center critically ill patient database from January 2014 to December 2015.A total of 4689 patients were included in this study.The Hb levels were divided into 3 groups:Hb<6 g/dL(Group 1),6 g/dL≤Hb<8 g/dL(Group 2),and Hb≥8 g/dL(Group 3).Based on the ad-ministration of PRBC transfusion,each group was subdivided into PRBC and non-PRBC groups.Results:A total of 4689 patients were enrolled in the study,including 825,2195,and 1669 patients in Groups 1,2,and 3,respectively.Furthermore,the PRBC and non-PRBC groups consisted of 1847 and 2842 patients,respectively.There was no significant difference in the 30-day mortality rate between Group 1 and Group 2 or between the PRBC and non-PRBC subgroups.In Group 3,the 30-day mor-tality rate of patients who received transfusion was higher than that of patients who did not(13.29%vs 9.14%,P=0.029).For the PRBC group,the difference in 30-day mortality rate was not statistically significant among the 3 groups,whereas for the non-PRBC group,the 30-day mortality rate in Group 3 was the lowest,and there was a significant difference among the 3 groups(P=0.003).There was no significant difference in the subgroup analysis of bleeding at different sites and etiologies.Conclusion:Packed red blood cell transfusion does not improve prognosis or reduce mortality in patients with UGIB but may increase mortality in patients with Hb levels greater than 8 g/dL.
基金supported by the Sponsorship of Graduate Student Research under the CU Academic Network in the region(CU-ANR-57-01),Chulalongkorn Universitythe 90th Anniversary of Chulalongkorn University Fund(Ratchadaphiseksomphot Endowment Fund)
文摘The rice field frog Hoplobatrachus rugulosus is an important anuran species found in wetlands throughout Thailand. At present, the hematological parameters of wild populations are unknown. Therefore, hematological and morphological characteristics of peripheral blood cells of wild-caught H. rugulosus were examined. Thirty-three adult frogs (17 male and 16 female frogs) were collected from a natural population in Nan Province, northem Thailand during the wet season of 2014. Blood samples were analyzed by packed cell volume (PCV) and blood cell counts from hemocytometer and Giemsa-stained blood smears. The mean PCV of male frogs (30.70% ±6.07%) was significantly higher than that of the female frogs (25.09%± 4.85%). The mean number of lymphocytes and neutrophils also showed significant sex-related differences. Moreover, the morphometric analysis of blood cells revealed dimensions as follows: erythrocytes (17.96 ±1.44 μm length × 11.50 ± 1.09μm width), immature erythrocytes (14.91 ± 2.20 μm diameter), thrombocytes (13.93± 3.14 μm length × 7.05 ± 1.31 μm width), lymphocytes (11.01 ±2.69μm diameter), monocytes (12.04±2.40 μm diameter), neutrophils (12.58 -±2.08μm diameter), basophils (13.60 ± 2.17μm diameter) and eosinophils (12.33 ± 2.95 μm diameter). Overall, the hematological parameters obtained in this study could be regarded as the first report and a crucial baseline data of wild H. rugulosus in Thailand that can be used for monitoring the health status of this anuran.
文摘<strong>Background: </strong>The December 2019 Chinese epidemic of Corona Virus Disease [COVID-19], which erupted in Wuhan, South China, was declared a pandemic, by the World Health Organization [WHO], on 12<sup>th</sup> January 2020. The worldwide spread from China was rapid, but Africa was the last port-of-call. Her first diagnosed case was two months after China’s, on 14<sup>th</sup> February, 2020 in Egypt. The morbidity and mortality rates have, however, remained lower in Africa than in the developed world, and analysts believe that it was more of a temporary respite, since Africa’s poor health infrastructure will become her eventual albatross. <strong>Methodology:</strong> Data were collected on COVID-19 and records of the socio-economic capacity of Africa by accessing the relevant previous and current peer-reviewed publications from multiple search engines on internet. The data were, then, collated and comparatively analyzed. <strong>Results: </strong>The available data revealed that Africa had, mostly, the milder forms of COVID-19, and so, morbidity and mortality were low. Her shrinking elderly population and hot climate were believed to be contributory, but lately, as the pandemic spread, the role of these factors was not exactly predictive. Being low on healthcare infrastructure, Africa could tenaciously leverage on the supportive and preventive measures prescribed by WHO, while the world awaited a vaccine. The role of ventilators in the care of critically ill patients, also, came under scrutiny as some workers were questioning the underlying pathology, and advocating a paradigm shift from high-tech positive end expiratory pressure ventilation to plasmapheresis and packed cell transfusion. <strong>Conclusion:</strong> Africa faces a huge challenge with COVID-19, but the predicted heavy mortalities may be reduced by some local confounding factors, control of spread and re-focusing of critical care away from the expensive and unavailable ventilators.
文摘Background Prior studies report conflicting evidence on the association between packed red blood cell(PRBC)transfu-sions and necrotizing enterocolitis(NEC),especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC.The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life(DOL)14 in very premature neonates.Methods A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14.Primary endpoints were PRBC transfusions after DOL 14 until the date of NEC diagnosis,discharge,or death.Wilcoxon ranked-sum and Fisher's exact tests,Cox proportional hazards regression,and Kaplan-Meier curves were used to analyze data.Results Of 549 premature neonates,186(34%)received transfusions after DOL 14 and nine(2%)developed NEC(median DOL=38;interquartile range=32-46).Of the nine with NEC after DOL 14,all were previously transfused(P<0.001);therefore,hazard of NEC could not be estimated.Post hoc analysis of patients from DOL 10 onward included five additional patients who developed NEC between DOL 10 and DOL 14,and the hazard of NEC increased by a factor of nearly six after PRBC transfusion(hazard ratio=5.76,95%confidence interval=1.02-32.7;P=0.048).Conclusions Transfusions were strongly associated with NEC after DOL 14.Prospective studies are needed to determine if restrictive transfusion practices can decrease incidence of NEC after DOL 14.