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Transfusion-Related Necrotizing Enterocolitis: A Conceptual Framework

Marin, Terri PhD, NNP-BC; Strickland, Ora L. PhD, RN

Section Editor(s): Zukowsky, Ksenia

doi: 10.1097/ANC.0b013e318285f901
Beyond the Basics

Necrotizing enterocolitis (NEC) is a disease primarily of prematurity characterized by partial or entire gut necrosis and is associated with significant mortality and morbidity. Recent studies report that approximately 25% to 35% of very low-birth-weight infants less than 1500 g receiving packed red blood cell transfusions develop temporally associated NEC, known as transfusion-related NEC (TR-NEC). Although there are many known risk factors for NEC, this article focuses on 3 contributing factors: packed red blood cell transfusions, enteral feedings, and gastrointestinal immaturity. Previous data suggest that these factors may interact to affect neonatal intestinal tissue oxygenation, which may lead to tissue ischemia, resulting in intestinal injury. This article presents a conceptual framework that combines current theoretical perspectives for TR-NEC, and reviews previous research examining related variables and how their interaction may increase the risk for TR-NEC development. In addition, incorporation of the proposed framework to guide future research and nursing care in this area is discussed.

Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Marin); and School of Nursing and Health Sciences, Florida International University, Miami (Dr Strickland).

Correspondence: Terri Marin, PhD, NNP-BC, Office 344, 1520 Clifton Dr NE, Atlanta, GA 30322 (

Dr Marin has received an honorarium for presentation of this material from the Florida Association of Neonatal Nurse Practitioners and a grant from the Florida Association of Neonatal Nurse Practitioners and Sigma Theta Tau International Honor Society of Nursing for work associated with this manuscript.

The authors declare no conflict of interest.

© 2013 by The National Association of Neonatal Nurses