Transient effects of transfusion and feeding advances (volumetric and caloric) on necrotizing enterocolitis development: A case-crossover study

Le, Vi T.; Klebanoff, Mark A.; Talavera, María; Slaughter, Jonathan L.

doi:10.1371/journal.pone.0179724

Cited by 21 publications

(15 citation statements)

References 25 publications

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“…Similar to our research, in the study by VT Le in case-crossover research for assessment of the NEC and the forti cation and volume increase of milk, in 63 preterm infants<32 weeks of gestation, they did not detect any effect of the forti cation and volume of the milk and GI problems (14), inversely some other studies such as Alfaleh showed that PCT was associated with the lower rate of NEC in preterm infants (15).…”

Section: Discussionsupporting

confidence: 90%

Packed Cell Transfusion and Feeding Tolerance in Well Preterm Infants: A Randomized Clinical Trial

Kazemian

Fallahi

Kashani

et al. 2020

Preprint

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Background: The correlation between necrotizing enteroculitis (NEC) and packed cell transfusion (PCT) has recently been identified. Based on some research, 25–35% of NEC has been linked to transfusion, we planned this study to determine, the association between PCT and feeding tolerance in well preterm newborns.Method: Our study was a clinical trial study in preterm infants admitted to NICU of Mofid Children's Hospital from April 2017 to May 2018.Seventy well premature babies with a birth weight of <1500 grams and gestational age <32 weeks with enteral feeding, who need PCT were enrolled. The eligible patients divided by simple randomization to two groups, in the intervention group (35 patients) the baby's breastfeeding withholding just during the time of PCT and continue as usual after that, but in control groups (35 patients) feeding of neonates is given as usual regardless of PCT. The feeding tolerance during the first 72 hours after transfusion was compared between the two groups. Sick neonates exclude from the study. Data analysis was performed in SPSS version 20.Results: The mean gestational age, birth weights, and postnatal age in the intervention group were 30.13 weeks, 1245.71grams, and 17 days respectively and in the control group were 29.97weeks, 1169.43grams and 15.46 days respectively without any statistically significant difference between them. Except for hemoglobin and hematocrit pre-transfusion, other characteristics of patients were similar. In the evaluation of feeding tolerance after transfusion during 24, 48 and 72 hours, 32(91.2%), 33(94.73%), 34(97.1%) of both groups, had feeding tolerance with no significant difference There were no statistically significant differences between neonates with and without the feeding tolerance in the patients of each group.Conclusion: Our research showed that in well preterm neonates with a good general condition, during PCT, withholding of feeding, isn’t necessary and continued breastfeeding seems to be safe.Trial registration: All ethical considerations of the study were approved by the institutional review board and the research ethics committee at Shahid Beheshti University of Medical Sciences, Tehran, Iran (IR. SBMU.RETECH.1395.1010) and granted ethical approval and the Iranian Registry of Clinical Trial code are IRCT20200419047136N1.Approved by Iranian Registry of Clinical TrialsTrial Id: 47347IRCT Id: IRCT20200419047136N1Registration date: 2020-05-04, 1399/02/15(The link directly for trial registration: https://en.irct.ir/trial/47347)Approved by Research Ethics Committee: IR. SBMU.RETECH.1395.1010

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Section: Discussionsupporting

confidence: 90%

Packed Cell Transfusion and Feeding Tolerance in Well Preterm Infants: A Randomized Clinical Trial

Kazemian

Fallahi

Kashani

et al. 2020

Preprint

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“…In line with the present research, a case-crossover study by Le VT et al on NEC, milk fortification, and milk volume increase showed that milk fortification and volume had no associations with GI problems in 63 preterm infants < 32 weeks of gestation (15). Conversely, some other studies, including the one conducted by Alfaleh et al, showed that PCT was associated with a lower rate of NEC in preterm infants (16).…”

Section: Discussionsupporting

confidence: 89%

Packed Cell Transfusion and Feeding Tolerance in Healthy Preterm Infants: A Randomized Clinical Trial

et al. 2021

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Background: Recently, the correlation between necrotizing enterocolitis (NEC) and packed cell transfusion (PCT) has been identified. Evidence shows that 25 - 35% of NEC cases are associated with PCT. Objectives: this study aimed to determine the association between PCT and feeding tolerance in healthy preterm newborns. Methods: Materials and Methods: This clinical trial was performed on preterm infants, admitted to the neonatal intensive care unit (NICU) of Mofid Children's Hospital, Tehran, Iran, from April 2017 to May 2018. A total of 70 healthy premature infants (birth weight < 1500 g and gestational age < 32 weeks) with enteral feeding, who required PCT, were included in this study. The eligible infants were divided into two groups by simple randomization. In the intervention group (n = 35), breastfeeding was withheld only during PCT and then continued as usual. On the other hand, in the control group (n = 35), feeding was performed as usual, regardless of PCT. Feeding tolerance within the first 72 hours post-transfusion was compared between the two groups. Sick newborns were excluded from the study. Data analysis was performed in SPSS version 20. Results: The mean gestational age, birth weight, and postnatal age of the neonates were 30.13 weeks, 1245.71 g, and 17 days in the intervention group and 29.97 weeks, 1169.43 g, and 15.46 days in the control group, respectively; there was no significant difference between the two groups. Except for pre-transfusion hemoglobin and hematocrit levels, other characteristics of the two groups were similar. Feeding tolerance was reported in 32 (91.2%), 33 (94.73%), and 34 (97.1%) newborns at 24, 48, and 72 hours post-transfusion in both groups, without any significant difference. There was no significant difference between neonates with and without feeding tolerance in either of the groups. Conclusions: According to the present results, withholding feeding during PCT is not necessary in healthy preterm neonates with a good general condition, and continued breastfeeding seems to be a safe option.

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“…All these measures are indicative of confounding as these may be related to delayed introduction or interruption of feeds and are themselves associated with development of NEC. Therefore, certain authors argue that the risk of NEC should not be considered in isolation of other potential clinical outcomes while formulating feeding policies and practices for preterm infants [ 20 ]. Clinical studies have evaluated the effects of different feeding regimens on the incidence of NEC and outcomes in premature neonates [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of Nil Per Os (NPO) Days with Necrotizing Enterocolitis

Wang

Guo

2018

Gastroenterology Research and Practice

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Background Enteral feeds are an essential part of care for infants and may be a potential risk factor in NEC development. The present study objective was to evaluate the relationship between nil per os (NPO) and clinical outcomes in infants with NEC. Methods This was a retrospective review of 196 premature, low-birth-weight infants with NEC from January 1, 2011, to October 31, 2016, at four academic tertiary care hospitals. The patients were evaluated based on the median nil per os (NPO) days (5.6 days) in longer NPO (6.3 ± 1.1 days) versus shorter NPO groups (4.2 ± 0.9 days). Results Patients who experienced longer than 5.6 NPO days were more likely associated with perforated NEC (odds ratio (OR), 2.01; 95% confidence interval (CI), 1.07–3.76; p = 0.021), stage III NEC (OR, 1.81; 95% CI, 0.97–3.38; p = 0.042), and longer duration of mechanical ventilation (OR, 0.17; 95% CI, 0.08–0.98; p = 0.005) than the shorter duration group of 5.6 NPO days. For the secondary outcomes, there was a trend towards earlier birth (p = 0.083), longer NICU length of stay (p = 0.093), and higher mortality (p = 0.10) in the longer NPO cohort (p = 0.057). The incidence of bacterial sepsis and short bowel syndrome also increased as the length of NPO increased. There was no statistically significant difference in nutritional variables between the two groups within the in-hospital period. Conclusion Longer NPO time was associated with the severity of NEC and more injurious clinical outcomes, as demonstrated by rates of surgical intervention and duration of mechanical ventilation.

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Transient effects of transfusion and feeding advances (volumetric and caloric) on necrotizing enterocolitis development: A case-crossover study

Cited by 21 publications

References 25 publications

Packed Cell Transfusion and Feeding Tolerance in Well Preterm Infants: A Randomized Clinical Trial

Packed Cell Transfusion and Feeding Tolerance in Well Preterm Infants: A Randomized Clinical Trial

Packed Cell Transfusion and Feeding Tolerance in Healthy Preterm Infants: A Randomized Clinical Trial

The Association of Nil Per Os (NPO) Days with Necrotizing Enterocolitis

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