![]() ![]() 19, 20 Physiologic studies in animals 16, 21 and preterm newborns 15, 22 on the association of anemia and transfusion with postprandial mesenteric blood flow and/or tissue oxygen levels are limited. As a result, feeding practices during the peritransfusion period are variable in different neonatal intensive care units. 18 Some clinical studies 2, 6, 7 have found variable results regarding the role of feeding in infants with TANEC, with some showing no benefit of withholding feeding from infants during the transfusion period, whereas others 3, 4, 5, 12 suggest an association between feeding and TANEC. 11 Although the pathogenesis of TANEC is unclear, a proposed hypothesis includes transfusion-induced splanchnic hypoperfusion, further exacerbated by feeding 5, 14, 15 in the context of anemia, 15, 16, 17 and vulnerable splanchnic microcirculation in premature infants. 1, 2, 3, 5, 6, 8, 9, 10, 11, 12, 13 Cases of TANEC are reported to be associated with transfusion of red blood cells stored for a longer period and transfusion given for significant anemia. 1 In general, TANEC has delayed postnatal age at onset, and infants tend to be of lower gestational age and birth weight, to be sicker on the first days of life, and to have higher odds of having patent ductus arteriosus (PDA). ![]() Compared with classic NEC, transfusion-associated NEC (TANEC) cases are more severe, 2 with higher rates of surgical intervention 6 and mortality. Several studies 1, 2, 3, 4, 5, 6, 7 suggest a temporal association between packed red blood cell transfusion (PRBCT) in the 48 to 72 hours preceding PRBCT and the development of necrotizing enterocolitis (NEC) in low-birth-weight infants. The primary and exploratory analyses found no association between FTOEc and feeding phases, suggesting that cerebral oxygenation may be protected. ![]() However exploratory analyses of postprandial changes in FTOEs undertaken for each transfusion epoch separately found evidence of increased postprandial FTOEs during TE1 (mean FTOEs, 10.55 at FP0 vs 13.21 at FP4, P =. No overall association was found between FTOEs and FPs in a multivariable repeated-measures model that accounted for transfusion epochs (primary analysis approach) (FP0: mean estimate, 11.64 95% CI, 9.55-13.73 FP1: mean estimate, 12.02 95% CI, 9.92-14.11 FP2: mean estimate, 12.77 95% CI, 10.68-14.87 FP3: mean estimate, 12.54 95% CI, 10.45-14.64 FP4: mean estimate, 12.98 95% CI, 10.89-15.08 P =. Results:Of 25 enrolled infants (13 female median birth weight, 949 g median gestational age, 26.9 weeks median enrollment weight, 1670 g and median postmenstrual age, 34 weeks ), 1 infant was excluded because of corrupted near-infrared spectroscopy data. The intraindividual comparisons of feeding-related changes were evaluated during the pretransfusion epoch (TE0: 4 hours before onset of transfusion) and 3 TEs after transfusion (TE1: first 8 hours after PRBCT completion TE2: 9-16 hours after PRBCT completion and TE3: 17-24 hours after PRBCT completion). Main Outcomes and Measures:Splanchnic fractional tissue oxygen extraction (FTOEs) and cerebral fractional tissue oxygen extraction (FTOEc) measures were made during 75-minute feeding cycles that comprised a 15-minute preprandial feeding phase (FP0) and 4 contiguous 15-minute postprandial feeding phases (FP1, FP2, FP3, and FP4 each 15 minutes long). Exposures:Infants received PRBCT (15 mL/kg for 4 hours) and at least 120 mL/kg daily of second hourly bolus feedings. Data analysis was performed from August 1, 2017, to October 31, 2018. Design, Setting, and Participants:This prospective cohort study conducted from September 1, 2014, to November 30, 2016, at a tertiary neonatal intensive care unit included 25 hemodynamically stable infants with gestational age less than 32 weeks, birth weight less than 1500 g, and postmenstrual age younger than 37 weeks. Objective:To investigate the oxygen utilization efficiency of preterm gut and brain challenged with bolus feeding during anemia and after transfusion using near-infrared spectroscopy. Splanchnic hypoperfusion associated with packed red blood cell transfusion (PRBCT) and feeding has been implicated, but studies of splanchnic tissue oxygenation with respect to feeding plus PRBCT are lacking. Importance:The pathogenesis of transfusion-associated necrotizing enterocolitis remains elusive. ![]()
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