Feeding Practices and Effects on Transfusion-Associated Necrotizing Enterocolitis in Premature Neonates

Killion, Emma

doi:10.1097/anc.0000000000000872

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…Prior reviews have yielded conflicting conclusions regarding various feeding practices and the development of NEC. Nonetheless, we await results of the WHEAT trial (Withholding Enteral Feeds Around Packed Red Cell Transfusion to Prevent NEC in Preterm Neonates), which tests the effects of witholding enteral feeding during RBC transfusions on risk reduction of NEC . Our secondary analysis did not delve into the association between enteral feeding during RBC transfusions and NEC.…”

Section: Discussionmentioning

confidence: 99%

Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis

Salas,

Gunn,

Carlo

et al. 2024

JAMA Netw Open

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ImportanceObservational studies often report that anemia and red blood cell (RBC) transfusions are associated with a higher risk of necrotizing enterocolitis (NEC) among extremely low-birthweight (ELBW) infants.ObjectiveTo evaluate whether there is a temporal association between 72-hour hazard periods of exposure to RBC transfusions and NEC among ELBW infants randomized to either higher or lower hemoglobin transfusion thresholds.Design, Setting, and ParticipantsThis post hoc secondary analysis of 1690 ELBW infants who survived to postnatal day 10 enrolled in the Transfusion of Prematures (TOP) randomized multicenter trial between December 1, 2012, and April 12, 2017, was performed between June 2021 and July 2023.ExposuresFirst, the distribution of RBC transfusions and the occurrence of NEC up to postnatal day 60 were examined. Second, 72-hour posttransfusion periods were categorized as hazard periods and the pretransfusion periods of variable duration as control periods. Then, the risk of NEC in posttransfusion hazard periods was compared with that in pretransfusion control periods, stratifying the risk based on randomization group (higher or lower hemoglobin transfusion threshold group).Main Outcomes and MeasuresThe primary outcome was incidence of NEC stage 2 or 3. Secondary outcomes included the incidence rates of NEC within five 10-day intervals, taking into account the number of days at risk.ResultsOf 1824 ELBW infants randomized during the TOP trial, 1690 were included in the present analysis (mean [SD] gestational age, 26.0 [1.5] weeks; 899 infants [53.2%] were female). After categorizing 4947 hazard periods and 5813 control periods, we identified 133 NEC cases. Fifty-nine of these cases (44.4%) occurred during hazard periods. Baseline and clinical characteristics of infants with NEC during hazard periods did not differ from those of infants with NEC during control periods. The risk of NEC was 11.9 per 1000 posttransfusion hazard periods and 12.7 per 1000 control periods (adjusted risk ratio, 0.95; 95% CI, 0.68-1.32; P = .74). This risk did not differ significantly between randomization groups, but the incidence rate of NEC per 1000 days peaked between postnatal days 20 and 29 in the lower hemoglobin transfusion threshold group.Conclusions and RelevanceThe findings of this post hoc analysis suggest that, among ELBW infants with the hemoglobin ranges occurring in the TOP trial, exposure to RBC transfusions was not temporally associated with a higher risk of NEC during 72-hour posttransfusion hazard periods. Given that the incidence rate of NEC peaked between postnatal days 20 and 29 among infants with lower hemoglobin values, a more in-depth examination of this at-risk period using larger data sets is warranted.Trial RegistrationClinicalTrials.gov Identifier: NCT01702805

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Section: Discussionmentioning

confidence: 99%

Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis

Salas,

Gunn,

Carlo

et al. 2024

JAMA Netw Open

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“…The feed withholding time during this study was shorter than that; however, no differences in the incidence of TA-NEC and other symptoms of the feeding and withholding enteral feeding groups were observed. The intestinal transit times of premature infants are four-times greater than those of full-term infants; therefore, a 4-h fast may not have the desired effect of lowering NEC ( 35 ). In contrast to the studies by Schindler et al and others ( 15 , 36 ), we adopted a protocol involving an 8-h feeding withholding period for the withholding feeding group, from the start of the transfusion.…”

Section: Discussionmentioning

confidence: 99%

Effects of the feeding protocol during blood transfusion on splanchnic tissue oxygenation and complications in very premature infants

He,

Sun,

et al. 2024

Front. Nutr.

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BackgroundThe effects of blood transfusions on splanchnic oxygenation and complications related to blood transfusions, including red blood cell (RBC) transfusions, in premature infants undergoing enteral feeding, to provide clinical evidence for a management protocol for premature infants during the peri-transfusion period.MethodsThis single-blind, randomized, controlled trial enrolled sixty eligible preterm infants who were randomly divided into the withholding feeding group (n = 30) or feeding group (n = 30). Enteral feeding was withheld for 8 h, beginning from the start of transfusion infants in the feeding group were fed according to the pre-transfusion feeding approach during and after RBC transfusion.ResultsBaseline characteristics of those in the withholding and feeding groups were as follows: gestational age (weeks) 27.52 (24.86–30.14) and 27.13 (25.43–30.14); birth weight (g), 1,027 (620–1,450) and 1,027 (620–1,270); blood transfusion day, 48 (14–79) and 39 (10–78); and hemoglobin before blood transfusion (g/L), 81.67 (±10.56) and 85.93 (±14.77). No significant differences were observed between groups at baseline. No significant differences were observed in the average splanchnic tissue oxygenation changes or clinical results at any time. One patient in the withholding feeding group experienced transfusion-associated necrotizing enterocolitis.ConclusionsNo differences in splanchnic oxygenation observed these feeding protocols. This study suggests the feasibility of a sizable trial to evaluate clinical outcomes. The risks of mesenteric ischemia and transfusion-related necrotizing enterocolitis for premature infants were not increased by enteral feeding during RBC transfusion.Clinical trial registrationChiCTR2200055726 (https://www.chictr.org.cn/).

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“…НЭК новорождённых в период после кардиохирургических операций является сложным полиэтиологичным осложнением [8,12,35]. Ведущими патогенетическими факторами являются гипоксия и ишемия в перинатальном периоде, нерациональное питание новорождённых и выраженные нарушения микробиоты кишечника, коррекция которых была явно недостаточной и несвоевременной, особенно учитывая наличие грудного молока и пробиотиков направленного действия [36][37][38]. В наших наблюдениях у пациентов с тяжёлыми проявлениями НЭК отмечено, что все они поступали из родильного дома в тяжёлом состоянии на фоне интранатальной гипоксемии и внутриутробной пневмонии, которая усугубилась после операции в условиях ИК и гипотермии.…”

Section: Discussionunclassified

Features of the formation of necrotizing enterocolitis in cardiac surgery children patients

Sarsenbayeva,

Kim,

Berdibekov

2023

RPJ

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of the gastrointestinal tract (GIT) in patients. Necrotizing enterocolitis (NEC) remains the most complex and least studied problem in pediatrics, including cardiac surgery. In pediatric cardiac surgery, the decrease in perfusion of the internal organs of the abdominal cavity is due to low perfusion pressure during cardiopulmonary bypass, low cardiac output in the postoperative period, aggravation of sympathetic vasoconstriction due to the stress response to surgery, and the introduction of exogenous catecholamines. Objective: analysis of the features of the development of NEC in cardiac surgery children patients. Materials and methods. A prospective analysis of thirty cardiac surgery children patients with the development of gastrointestinal dysfunction after surgery was performed. All children underwent standard research methods. Results. In 63.3% of cases, children showed signs of dynamic intestinal obstruction; 36.7% of newborns have signs of necrotizing enterocolitis of varying degrees. The features of the bacteriological landscape, clinical manifestations and X-ray picture depending on the type of intestinal function disorder are presented. The role of hypoxia, hypoperfusion during cardiopulmonary bypass, the functioning of the open ductus arteriosus in “blue” patients in the formation of the risks of developing necrotizing enterocolitis is shown. Among the studied patients, according to the age structure, there were newborns — 18 (60%) patients, children under 6 months — 10 (33,3%); older than 1 year — 2 (96,6%). An analysis of clinical manifestations in children in the preoperative and postoperative periods showed 19 cases (63.3%) to have signs of dynamic intestinal obstruction. This group of children consisted of 8 newborns (36.8%) and 12 patients of the postnatal period. All patients were after heart surgery (2 patients after narrowing of the pulmonary artery and 10 cases cc were operated on under cardiopulmonary bypass). The most difficult and severe group of patients after heart and vascular surgery were children with congenital heart defects, who developed signs of NEC — 11 patients (36.6%). 10 children were neonates, 1 patient was ovet 5 years. It is shown that the development of such complications including infectious and hypoxic causes, heart failure, the duration of cardiopulmonary bypass and diastolic stealing of vessels is of decisive importance. Conclusions. Dysfunction of the gastrointestinal tract after heart surgery in children is one of the urgent problems of cardiac surgery. In the group of severe sick patients undergoing prolonged ventilation, morphine infusion, muscle relaxants, with signs of anasarca, the interpretation of the X-ray picture and the clinic of acute surgical pathology in the abdominal cavity may be difficult. NEC, occurred in newborns over the postoperative period, is often not recognized in a timely manner and leads to an unfavourable outcome.

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Feeding Practices and Effects on Transfusion-Associated Necrotizing Enterocolitis in Premature Neonates

Cited by 6 publications

References 28 publications

Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis

Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis

Effects of the feeding protocol during blood transfusion on splanchnic tissue oxygenation and complications in very premature infants

Features of the formation of necrotizing enterocolitis in cardiac surgery children patients

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