Necrotizing enterocolitis and the role of anemia of prematurity

Necrotizing enterocolitis (NEC) is one of the most common surgical diseases of preterm infants, with significant short- and long-term morbidity and mortality. Although the etiology of NEC remains elusive, multiple factors adversely affecting the intestinal mucosal integrity of preterm infants are known to be associated with NEC. Anemia and red blood cell (RBC) transfusion-related gut injury have been shown to have strong correlation with NEC. Anemia potentially compromises mucosal integrity with subsequent poor healing, and this injury may be augmented by yet unknown factors associated with RBC transfusions. Although convincing evidence is lacking, there is a need for guidelines to keep the hematocrit within clinically and physiologically relevant limits by appropriate interventions. Further investigations need to focus on assessing the interplay between anemia, chronically hypoxemic/hypoperfused intestines, and early iron therapy or other pharmacologic approaches for prevention/treatment of anemia and RBC transfusions.