Impact of feeding strategies during red blood cell transfusion on cerebral and splanchnic oxygenation in preterm infants: Randomized pilot study

Abstract

Background

Red blood cell (RBC) transfusion in very preterm infants has been linked to transfusion-related necrotizing enterocolitis (TR-NEC), and peri-transfusion feeding practices vary. We examined whether three different feeding strategies affect cerebral and splanchnic oxygenation.

Methods

In this single-center randomized pilot trial, infants <32 weeks’ gestation requiring RBC transfusion were allocated to feeds withheld, feeds reduced by 50%, or feeds continued during transfusion. Near-infrared spectroscopy measured cerebral and splanchnic rSO₂ from 2 h before transfusion start through 42 h after completion (covering the remainder of the 48-h post-initiation window used to define TR-NEC). FTOE and SCOR were calculated. Prespecified primary endpoints were between-group differences in changes in CrSO₂, SrSO₂, and corresponding FTOE across pre-specified epochs; secondary endpoints were feeding intolerance and TR-NEC (Bell stage ≥II within 48 h).

Results

Forty-five infants were enrolled (14, 14, and 17 per group). Splanchnic rSO₂ increased and splanchnic FTOE decreased during and after transfusion; cerebral rSO₂ increased after transfusion with decreased cerebral FTOE. No statistically significant differences in, FTOE, or SCOR were detected between feeding groups. TR-NEC occurred in eight infants (2, 1, and 5 per group). In exploratory analyses, infants who developed TR-NEC had lower splanchnic rSO₂ and higher splanchnic FTOE before and during transfusion.

Conclusions

No statistically significant differences were demonstrated in cerebral or splanchnic oxygenation among three feeding strategies during RBC transfusion. As a pilot, hypothesis-generating study, these findings should not be interpreted as equivalence between strategies and require confirmation in larger trials.