Impact of red blood cell transfusions on intestinal barrier function in preterm infants

Feeding Strategies in Preterm Very Low Birth-Weight Infants

“…This condition is defined as NEC occurring within 48 hours of a PRBC transfusion and may be associated with higher infant morbidity and mortality, including a higher surgical intervention rate than for NEC unrelated to a transfusion 40. The pathophysiological mechanisms for TANEC are unclear but may be related to altered mesenteric perfusion, increased intestinal permeability, pretransfusion anemia, reperfusion injury, or an intestinal immune reaction triggered by exposure to immunological mediators in PRBCs 41–43. Whether PRBC transfusion increases the risk of NEC remains controversial.…”

“…40 The pathophysiological mechanisms for TANEC are unclear but may be related to altered mesenteric perfusion, increased intestinal permeability, pretransfusion anemia, reperfusion injury, or an intestinal immune reaction triggered by exposure to immunological mediators in PRBCs. [41][42][43] Whether PRBC transfusion increases the risk of NEC remains controversial. Some studies suggest a clear association between transfusions and NEC, 44 while others report no definitive relationship.…”

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

“…Prematurity is the most consistently recognized risk factor for NEC, demonstrating an inverse relationship; lower birth weight further increases this risk. 20 Other proposed risks include lack of exposure to antenatal steroids, lower 5-minute Apgar score when compared with control groups, mechanical ventilation more than 1 week, prolonged use of antibiotics within the first 10 days of life, feeding practices, and PRBC transfusions 2,6,14,15,19,20,22,23 Premature infants with TANEC are more likely to require surgical intervention and are at increased risk of mortality. 20,23 TANEC, like NEC, is thought to be multifactorial.…”

“…1 The literature supports that certain populations of infants are at increased risk for the development of NEC. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] High-risk infants include very low-birth-weight (VLBW) infants (<1500 g), [4][5][6][7][8][9][10][11] infants with severe anemia (defined as hemoglobin ≤ to 8 g/dL or hematocrit ≤25%) 18 who receive RBC transfusions, [4][5][6][7][8][9][10][11][12][13][14][15][16] and infants born less than or equal to 32 weeks' gestation. [9][10][11][12][13][14]16,17 One controversy in literature and clinical practice is whether continuing to feed during the administration of PRBC transfusions increases the risk of developing TANEC among premature infants.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17] High-risk infants include very low-birth-weight (VLBW) infants (<1500 g), [4][5][6][7][8][9][10][11] infants with severe anemia (defined as hemoglobin ≤ to 8 g/dL or hematocrit ≤25%) 18 who receive RBC transfusions, [4][5][6][7][8][9][10][11][12][13][14][15][16] and infants born less than or equal to 32 weeks' gestation. [9][10][11][12][13][14]16,17 One controversy in literature and clinical practice is whether continuing to feed during the administration of PRBC transfusions increases the risk of developing TANEC among premature infants. While some studies support the theory that feeding practices around the administration of PRBC transfusions are associated with TANEC, especially in preterm and low-birth-weight infants, conflicting literature cites that there is no correlation between feeding during blood transfusions and the incidence of TANEC.…”