Slow enteral feeding decreases risk of transfusion associated necrotizing enterocolitis

Dako, J., Buzzard, J., Jain, M., Pandey, R., Groh-Wargo, S., Shekhawat, P. | JNPM 2018;

BACKGROUND: Necrotizing Enterocolitis (NEC) is a multifactorial condition where PRBC transfusion is associated with necrotizing enterocolitis (TANEC) in about a third of all cases of NEC. We have investigated the role of feeding practices in incidence of TANEC. We sought to compare infants diagnosed with TANEC versus infants diagnosed with classic NEC and investigated the effects of a standardized slow enteral feeding (SSEF) protocol on TANEC incidence as well as the effects of SSEF on growth of infants with NEC.
METHODS: We conducted a retrospective cohort study, where medical records of infants born in a tertiary care neonatal intensive care unit (level IIIb) from January 1997 to May 2014 with birth weight < 1500 grams and gestational age≤34 weeks with NEC stage IIa or greater according to the modified Bell’s staging were reviewed.
RESULTS: During the study period, 111 infants developed NEC, and 41/111 (37%) were diagnosed with TANEC. Infants with TANEC were smaller, more premature, had higher SNAPPE scores and were more anemic prior to transfusion compared with infants with ‘classic NEC’. The severity of NEC did not differ between the two groups, however, infants with TANEC had worse outcomes and longer NICU stays. Introduction of SSEF protocol, led to a significant decrease in TANEC. There was no difference in weight and head circumference of infants in the two groups at 2 years corrected age.
CONCLUSION: SSEF led to a significant reduction in the incidence of TANEC without impairing growth at 2 years corrected age.


*Corresponding Author: 

Prem Shekhawat, MD, Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center, 2500 MetroHealth drive, Cleveland, 44109, OH, USA. Tel.: +1 216 778 5937; Fax: +1 216 778 3252; E-mail: