Transfusion associated necrotizing enterocolitis?

A Blood Bank Compliance Officer reports that the Transfusion Services of a chain of hospitals are receiving requests from neonatologists to only transfuse RBCs that are less than 14 days old to neonates. Syringes of RBC aliquots are being returned unused if they contain red cells from RBC units over 14 days old. The neonatologists claim they MUST have fresh blood in order to prevent Necrotizing Enterocolitis (NEC). As the recent article in Transfusion, (Christensen, et al: Is "transfusion-associated necrotizing enteroclolitis" an authentic pathogenic entity?) seemed to say, Transfusion Associated NEC (TA-NEC) is a very complex disorder and the age of the blood did not seem to be as important as the feeding schedule around the transfusion time. The inquiring Compliance Officer and transfusion service directors have discussed this article and other articles with the neonatologists and examined at their internal outcomes data for NEC, but the neonatologists still insist on fresh blood. They are interested in what the community practice and practice of others is regarding the age of blood selected for transfusion to the neonate. Must RBCs be less than 14 days old to avoid NEC?

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