Comparing two different protocols in withholding feeds around time of packed red cell transfusion and occurrence of TANEC (Transfusion associated necrotizing enterocolitis) in preterm neonates

Necrotizing enterocolitis (NEC) is a gastrointestinal disease characterized by pneumatosis intestinalis, pneumoperitoneum, or intestinal necrosis accompanied by signs or symptoms of shock. Our study aims to determine incidence of occurrence of NEC in preterm neonates after red blood cell transfusion with different feeding protocols and to assess the value of withholding feeds around the pRBCs transfusion in decreasing the incidence of transfusion associated necrotizing enterocolitis (TANEC).

The study was done on 90 preterms who received packed red blood cells (pRBCs) during their admission in the neonatal intensive care unit (NICU). Theywere divided in two groups according to different feeding protocols; Group (A): 45 preterms where only one feed was withheld during pRBCs transfusion and Group (B): 45 preterms where feeds were withheld 4 hours before till 4 hours after pRBCs transfusion.

The incidence of transfusion related NEC (positive TANEC) in preterm neonates and other complications of prematurity such as (intracranial hemorrhage (ICH), bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA), retinopathy of prematurity (ROP) and pneumothorax in group (A) were relatively higher than those of group (B).

The modulation of feeding protocol and necessity of keeping nothing per oral (NPO) before, during and after blood transfusion. Significant risk factors for NEC occurrence are feeding preterm before and after pRBCS transfusion, low birth weight, low gestational age, low APGAR score.