Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Feeding during transfusion and the risk of necrotizing enterocolitis in preterm infants

Journal of Perinatology volume 39, pages 540–546 (2019)Cite this article

Subjects

Abstract

Objective

To evaluate the effect of withholding feeds during transfusion on transfusion associated acute gut injury (TRAGI).

Study design

Data were collected on 125 preterm infants before and after the practice of withholding feeds for 12–24 h during transfusion was instituted. Logistic regression was used to examine effects of withholding feeds on TRAGI rates.

Results

A total of 19 (15%) infants developed NEC; 6/19 (32%) had TRAGI. Postnatal hydrocortisone use was associated with TRAGI (OR 8.97; 95% CI 1.17–68.46, p = 0.034). There was no difference in NEC rates (15.8 vs. 14.7%) and the proportions (22.2 vs. 40%) of TRAGI in the two time periods before and after instituting the standardized feeding regimen and practice of holding feeds during transfusion.

Conclusion

No significant decrease was noted in the rates of TRAGI after feeds were withheld during transfusion. Further studies are warranted to explore the relationship between feeds during transfusion and NEC.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA. 2015;314:1039–51.

    Article  CAS  Google Scholar 

  2. Fitzgibbons SC, Ching Y, Yu D, Carpenter J, Kenny M, Weldon C, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg. 2009;44:1072–5.

    Article  Google Scholar 

  3. Jasani B, Patole S. Standardized feeding regimen for reducing necrotizing enterocolitis in preterm infants: an updated systematic review. J Perinatol. 2017;37:827–33.

    Article  CAS  Google Scholar 

  4. Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data. Pediatrics. 2012;129:529–40.

    Article  Google Scholar 

  5. Josephson CD, Wesolowski A, Bao G, Sola-Visner MC, Dudell G, Castillejo MI, et al. Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants? J Pediatr. 2010;157:972–8.

    Article  Google Scholar 

  6. Bak SY, Lee S, Park JH, Park KH, Jeon JH. Analysis of the association between necrotizing enterocolitis and transfusion of red blood cell in very low birth weight preterm infants. Korean J Pediatr. 2013;56:112–5.

    Article  Google Scholar 

  7. Stritzke AI, Smyth J, Synnes A, Lee SK, Shah PS. Transfusion-associated necrotising enterocolitis in neonates. Arch Dis Child Fetal Neonatal Ed. 2013;98:F10–F14.

    Article  Google Scholar 

  8. Singh R, Visintainer PF, Frantz ID 3rd, Shah BL, Meyer KM, Favila SA, et al. Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants. J Perinatol. 2011;31:176–82.

    Article  CAS  Google Scholar 

  9. Mally P, Golombek SG, Mishra R, Nigam S, Mohandas K, Depalhma H, et al. Association of necrotizing enterocolitis with elective packed red blood cell transfusions in stable, growing, premature neonates. Am J Perinatol. 2006;23:451–8.

    Article  Google Scholar 

  10. Blau J, Calo JM, Dozor D, Sutton M, Alpan G, La Gamma EF. Transfusion-related acute gut injury: necrotizing enterocolitis in very low birth weight neonates after packed red blood cell transfusion. J Pediatr. 2011;158:403–9.

    Article  Google Scholar 

  11. Paul DA, Mackley A, Novitsky A, Zhao Y, Brooks A, Locke RG. Increased odds of necrotizing enterocolitis after transfusion of red blood cells in premature infants. Pediatrics. 2011;127:635–41.

    Article  Google Scholar 

  12. AlFaleh K, Al-Jebreen A, Baqays A, Al-Hallali A, Bedaiwi K, Al-Balahi N, et al. Association of packed red blood cell transfusion and necrotizing enterocolitis in very low birth weight infants. J Neonatal Perinat Med. 2014;7:193–8.

    CAS  Google Scholar 

  13. Sood BG, Rambhatla A, Thomas R, Chen X. Decreased hazard of necrotizing enterocolitis in preterm neonates receiving red cell transfusions. J Matern Fetal Neonatal Med. 2016;29:737–44.

    Article  Google Scholar 

  14. Elbaid MT, Harsono M, Talati Aj, Dhanireddy R. Effect of birth weight on the association between necrotising enterocolitis and red blood cell transfusions in ≤1500 g infants. BMJ Open. 2013;3:e003823.

  15. Marin T, Josephson CD, Kosmetatos N, Higgins M, Moore JE. Feeding preterm infants during red blood cell transfusion is associated with a decline in postprandial mesenteric oxygenation. J Pediatr. 2014;165:464–71.

    Article  Google Scholar 

  16. El-Dib M, Narang S, Lee E, Massaro AN, Aly H. Red blood cell transfusion, feeding and necrotizing enterocolitis in preterm infants. J Perinatol. 2011;31:183–7.

    Article  CAS  Google Scholar 

  17. Derienzo C, Smith PB, Tanaka D, Bandarenko N, Campbell ML, Herman A, et al. Feeding practices and other risk factors for developing transfusion-associated necrotizing enterocolitis. Early Hum Dev. 2014;90:237–40.

    Article  Google Scholar 

  18. Doty M, Wade C, Farr J, Gomezcoello VC, Martin G, Nasr T. Feeding during blood transfusions and the association with necrotizing enterocolitis. Am J Perinatol. 2016;33:882–6.

    Article  Google Scholar 

  19. Ohls RK, Ehrenkranz RA, Wright LL, et al. Effects of early erythropoietin therapy on the transfusion requirements of preterm infants below 1250 grams birth weight: a multicenter, randomized, controlled trial. Pediatrics. 2001;108:934–42.

    Article  CAS  Google Scholar 

  20. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 g. J Pediatr. 1978;92:529–34.

    Article  CAS  Google Scholar 

  21. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin N Am. 1986;33:179–201.

  22. Patel RM, Knezevic A, Shenvi N, Hinkes M, Keene S, Roback JD, et al. Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight infants. JAMA. 2016;315:889–97.

    Article  CAS  Google Scholar 

  23. Kirsten GF, Smith J, Pieper C, Bird A, Wessels G, Riphagen S, et al. The necessity for T-cryptantigen activation screening in babies with necrotising enterocolitis. S Afr Med J. 1996;86:546–8.

    CAS  PubMed  Google Scholar 

  24. Klein RL, Novak RW, Novak PE. T-cryptantigen exposure in neonatal necrotizing enterocolitis. J Pediatr Surg. 1986;21:1155–8.

    Article  CAS  Google Scholar 

  25. Hall N, Ong EG, Ade-Ajayi N, Fasoli L, Ververidis M, Kiely EM, et al. T cryptantigen activation is associated with advanced necrotizing enterocolitis. J Pediatr Surg. 2002;37:791–3.

    Article  CAS  Google Scholar 

  26. Perciaccante JV, Young TE. Necrotizing Enterocolitis associated with packed red blood cell transfusions in premature neonates. E-Pas. 2008;5839:5838.

    Google Scholar 

  27. Talavera MM, Bixler G, Cozzi C, Dail J, Miller RR, McClead R Jr, et al. Quality improvement initiative to reduce the necrotizing enterocolitis rate in premature infants. Pediatrics. 2016;137:e20151119. pii

    Article  Google Scholar 

  28. Jasani B, Rao S, Patole S. Withholding feeds and transfusion-associated necrotizing enterocolitis in preterm infants: a systematic review. Adv Nutr. 2017;8:764–9.

    Article  Google Scholar 

  29. Krimmel GA, Baker R, Yanowitz TD. Blood transfusion alters the superior mesenteric artery blood flow velocity response to feeding in premature infants. Am J Perinatol. 2009;26:99–105.

    Article  Google Scholar 

  30. Corvaglia L, Martini S, Battistini B, Rucci P, Aceti A, Faldella G. Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants. Pediatr Res. 2014;76:81–85.

    Article  Google Scholar 

  31. Dave V, Brion LP, Campbell DE, Scheiner M, Raab C, Nafday SM. Splanchnic tissue oxygenation, but not brain tissue oxygenation,increases after feeds in stable preterm neonates tolerating full bolus orogastric feeding. J Perinatol. 2009;29:213–8.

    Article  CAS  Google Scholar 

Download references

Author contributions

MB: Conceptualized and designed the study. Collected and analyzed data. Wrote the first draft of manuscript and reviewed and revised the manuscript. ML: Conceptualized and designed the study, collected data, reviewed and approved the manuscript. AH: Collected data, reviewed and approved the manuscript. GN: Conceptualized and designed the study. Analyzed data. Critically reviewed, revised and approved the manuscript.

Author information

Authors and Affiliations

  1. Carman and Ann Department of Pediatrics, Department of Pediatrics, Hutzel Women’s Hospital, 3980 John R Rd, Detroit, MI, 48201, USA

    Monika Bajaj & Girija Natarajan

  2. Department of Pharmacy, Wayne State University, Detroit, MI, 48201, USA

    Mirjana Lulic-Botica & Amber Hanson

Authors
  1. Monika Bajaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mirjana Lulic-Botica
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amber Hanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Girija Natarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monika Bajaj.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bajaj, M., Lulic-Botica, M., Hanson, A. et al. Feeding during transfusion and the risk of necrotizing enterocolitis in preterm infants. J Perinatol 39, 540–546 (2019). https://doi.org/10.1038/s41372-019-0328-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0328-7

This article is cited by

Search

Advanced search

Quick links