Stopping enteral feeds for prevention of transfusion-associated necrotising enterocolitis in preterm infants

Yeo, Kee Thai; Kong, Juin Yee; Sasi, Arun; Tan, Kenneth; Lai, Nai Ming; Schindler, Tim

doi:10.1002/14651858.cd012888.pub2

Cited by 16 publications

(20 citation statements)

References 24 publications

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“…The absence of demonstrable differences in splanchnic oxygenation between feeding regimens highlights the importance of conducting a trial that investigates clinical outcomes. The effect of feeding a baby during a RBC transfusion and the subsequent development of NEC remains unclear [21]. A systematic review of "before-after" studies (7 studies; 7492 infants) showed a significant reduction in the risk of developing NEC within 48-72 h when feeds were withheld during a transfusion [22].…”

Section: Discussionmentioning

confidence: 99%

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

et al. 2020

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Background: Necrotising Enterocolitis (NEC) is a devastating neonatal disease. A temporal association between red cell transfusion and NEC has been recognized and there have been concerns about the effects of feeding during transfusion. We aimed to assess the effect of different enteral feeding regimens on splanchnic oxygenation in preterm infants receiving red cell transfusions. Methods: This was an open, multi-arm, parallel-group, randomised controlled trial conducted in a single centre in Australia. We compared three different enteral feeding regimes during a single red cell transfusion in preterm infants < 35 weeks gestational age at birth. Infants were randomised to either: (1) Withholding enteral feeds for 12 h from the start of transfusion or; (2) Continuing enteral feeds or; (3) Restriction of enteral feed volume to 120 ml/kg/ day (maximum 20 kcal/30 ml) for 12 h. The primary outcome was mean splanchnic-cerebral oxygenation ratio (SCOR) and mean splanchnic fractional oxygen extraction (FOE) before (1 h prior), during (1 h into transfusion) and after (end of transfusion; 12 and 24 h post) transfusion. Results: There were 60 transfusion episodes (20 transfusion episodes in each group) included in the analysis. 41 infants with a median gestational age at birth of 27 weeks (range 23-32 weeks) were enrolled. The median postnatal age was 43 days (range 19-94 days) and the median pre-transfusion haematocrit was 0.27 (range 0.22-0.32). All three groups were similar at baseline. There were no differences in mean SCOR and mean splanchnic FOE at any of the pre-specified time points. There were also no differences in clinical outcomes. There were no episodes of NEC in any infant. Across all groups the mean SCOR increased from the start to the end of each transfusion (0.97 [CI95% 0.96-0.98] vs 1.00 [CI95% 0.99-1.01]; p = 0.04) and the mean FOE decreased from the start to the end of each transfusion (0.22 [CI95% 0.21-0.23] vs 0.17 [CI95% 0.16-0.18]; p < 0.001). Conclusions: There were no differences in splanchnic oxygenation when enteral feeds were either withheld, continued or restricted during a transfusion. However, the successful conduct of this study supports the feasibility of a large trial powered to assess clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

et al. 2020

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“…With further consideration to NEC, the American Society for Parenteral and Enteral Nutrition (ASPEN) recommends starting minimal enteral feeding within the first two days of life for infants ≥1000 g [ 11 ]. For infants receiving enteral feeding but in need of blood transfusion, a 2019 Cochrane review concluded there is insufficient evidence to indicate if holding enteral feeding has any effect on developing NEC [ 53 ]. Similarly, monitoring gastric residuals is not necessary as an assessment of feeding tolerance to prevent NEC, as a 2019 Cochrane review found no benefit to this practice [ 54 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits

Thoene

Anderson‐Berry

2021

Nutrients

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Enteral feeding is the preferred method of nutrient provision for preterm infants. Though parenteral nutrition remains an alternative to provide critical nutrition after preterm delivery, the literature suggests that enteral feeding still confers significant nutritional and non-nutritional benefits. Therefore, the purpose of this narrative review is to summarize health and clinical benefits of early enteral feeding within the first month of life in preterm infants. Likewise, this review also proposes methods to improve enteral delivery in clinical care, including a proposal for decision-making of initiation and advancement of enteral feeding. An extensive literature review assessed enteral studies in preterm infants with subsequent outcomes. The findings support the early initiation and advancement of enteral feeding impact preterm infant health by enhancing micronutrient delivery, promoting intestinal development and maturation, stimulating microbiome development, reducing inflammation, and enhancing brain growth and neurodevelopment. Clinicians must consider these short- and long-term implications when caring for preterm infants.

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“…The association between NEC and RBC transfusion has been discredited even by a recent review of the literature [ 79 ]. Furthermore, in a Cochrane review published in 2019 there were insufficient data to evaluate whether stopping feeds during blood transfusion is helpful in preventing the disease [ 80 ].…”

Section: Factors To Prevent Nec Developmentmentioning

confidence: 99%

Optimizing Nutritional Strategies to Prevent Necrotizing Enterocolitis and Growth Failure after Bowel Resection

et al. 2021

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Necrotizing enterocolitis (NEC), the first cause of short bowel syndrome (SBS) in the neonate, is a serious neonatal gastrointestinal disease with an incidence of up to 11% in preterm newborns less than 1500 g of birth weight. The rate of severe NEC requiring surgery remains high, and it is estimated between 20–50%. Newborns who develop SBS need prolonged parenteral nutrition (PN), experience nutrient deficiency, failure to thrive and are at risk of neurodevelopmental impairment. Prevention of NEC is therefore mandatory to avoid SBS and its associated morbidities. In this regard, nutritional practices seem to play a key role in early life. Individualized medical and surgical therapies, as well as intestinal rehabilitation programs, are fundamental in the achievement of enteral autonomy in infants with acquired SBS. In this descriptive review, we describe the most recent evidence on nutritional practices to prevent NEC, the available tools to early detect it, the surgical management to limit bowel resection and the best nutrition to sustain growth and intestinal function.

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Stopping enteral feeds for prevention of transfusion-associated necrotising enterocolitis in preterm infants

Cited by 16 publications

References 24 publications

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits

Optimizing Nutritional Strategies to Prevent Necrotizing Enterocolitis and Growth Failure after Bowel Resection

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