We read with interest the recently published article on relationship between packed red blood cell (PRBC) transfusion and severe form of necrotizing enterocolitis (NEC) [1].

The association between NEC and blood transfusion has been reported previously in case control studies but no strong evidence is available till now [2]. The authors have concluded that blood transfusion-associated NEC (TANEC) is severe, and is mainly a surgical form of the disease (stage 3a+3b), but number of TANEC cases with this staging and their comparative value in the other NEC group are not reported. Authors also mention that TANEC group was more likely to be of blood type B+ and less likely to be type A+. Data for this inference are not available in the results. Also, in the present study, we feel there are many confounders. The mean birth weight (992.8 g) and gestation age (27.3 weeks) in TANEC group was less compared to other NEC group. A multivariate analysis adjusted with these confounders is important. Significant number of more females in TANEC group is a new finding in the study not reported previously.

The association between NEC and blood transfusion demands a strong evidence of multi-center prospective randomized trial while addressing the confounders.

1. Garg PM Ravisankar S, Bian H, Macgilvray S, Shekhawat PS. Relationship between packed red blood cell transfusion and severe form of necrotizing enterocolitis: A case control study. Indian Pediatr. 2015;52:1041-5.