Non–blood group-specific red blood cell transfusions in preterm infants and necrotizing enterocolitis

We were interested in the report by Blau et al¹ on transfusion-related gut injury (TRAGI) as an etiology for necrotizing enterocolitis (NEC). We hypothesized that TRAGI might be an immune-mediated antigenic response to receiving non group-specific red blood cell (RBC) transfusions. RBC alloantibody formation in infants aged <4 months is rare, and thus all neonates receive group O blood.² We used a prospective database of confirmed cases of NEC (Bell’s staging ≥2) from 2006-2010 in a level III neonatal intensive care unit. Out of 44 177 births over the 4-year study period, 602 infants (1.3%) were born at a weight of <1500 g, of whom 39 developed NEC. Nine infants with a birth weight (BW) of >1500 g also developed NEC, for a total of 48 cases of NEC.