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.
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