There have been multiple debates about this so called "TRAGI". Strong evidence? Probably not. Personally opinion "no proof or disaproof". But, out group will withdold feeding for several hours as division policy.

Well, I for one have not observed adversities in pretermers who had ongoing feeds during BTs. I did have 3 in-born VLBWs and out of them 1 did require BT. The baby was on NG feeds, no adversities were noted. I had also administered probiotics twice daily for 5 days, and the overall experience was satisfactory, with good weight gain. The baby was discharged on day 32, and is healthy on follow up.

This is in contrast to an out-born 33 weeker referred to us on day 4 of life with history of reduced feeding. Sepsis workup was positive, and eventhough antibiotic coverage was reasonably good, baby went on to develop NEC by day 8, which necessitated a step up on the antibiotics as well as with-holding of feeds.This baby too required BT. we were fortunate that the baby recovered well.

An interesting observation is that I have not observed any NECs in in-born babies at my current workplace, while in the institute where I was working previously (which had a huge number of referrals from the periphery, and heavy case load), there were a significantly higher number of NECs.

Has anyone else observed such trends?

Despite not having a formal policy on that matter, we tend to withhold feeding during RBC transfusion in unstable very preterm infants to avoid the risk of NEC. We have a low incidence of NEC at our unit but we felt that there was an association in some cases between NEC and previous RBC transfusion. This association is probably due to chance occurrence but it influences our decision to withhold feeding.

We do not withhold feeding during PRBC tranfusion previously and do nit find the association between NEC and transfusion. No idea whether it is due to the low incidence of NEC in iur unut. Hiwever, due to some papers talking about their association, we also change our policy to keep the feeding program (not increase the feeding amount if the patient is not full enteral feeding) during transfusion now.

We also withhold feeding during RBC transfusion in preterm infants. In fact some papers and some data from our unit demonstrated a decrease in mesenteric oxygenation patterns measured with Near infrared spectroscopy (NIRS) during blood transfusion, more pronounced in infants who develop NEC. (Red blood cell transfusion-related necrotizing enterocolitis in very-low-birthweight infants: a near-infrared spectroscopy investigation. Marin T. Transfusion. 2013 Nov;53(11):2650-8)

I agree with most of the previous comments about ,poor evidence or or against stoppage of feeds. A retrospective analysis via postal questionnaire in England has suggested that most units do not stop feeds during transfusion (fetal and neonatal --march 2014 vol 99 issue 2).

What is all the more variable is the timing of reintroduction of feeds .

In fact in our set up; the mother breast-feeds her baby EVEN DURING transfusion.

In last 20 cases so far-

The baby remains quiet, comfortable with mother's touch

Transfusion proceeds well

We continue with normal feeding practices. Mothers only breastfeed or feed expressed breast milk or donor breast milk. We very seldom see NEC in our unit.

through my past experience in NICU, there were no incidence of NEC associated with feeding during blood transfusion..tq to Ravi Patel for sharing the article

We must compare risk benefit ratio of withholding feeding for several hrs vs NEC in VLBW , I think answer is clear : stop feeding until conclusive data be available.

OUR INCIDENCE OF NEC VERY LOW, AND OVER MANY YEARS OF EXPERIENCE I HAVE SEEN FEW CASES OF PRETERM INFANTS DEVELOPED NEC AFTER BLOOD TRANSFUSION AND THEY WERE ON FEEDS.

WE DON'T HAVE GUIDLINE TO STOP FEEDING DURING TRANSFUSION, BUT MY PRACITCE NOT TO FEED AT LEAST DURING TRANSFUSION AND MAY FEW HOURS AFTER. (THIS PERSONAL PRACTICE WITHOUT CLEAR EVIDENCE YET WHAT TO DO!) 

My recommendation is to stop feeding during the transfusion until new information will be available. We have seen some cases of necrotizing enterocolitis associated to a blood transfusion in preterms.

Two recently published studies are probably of interest in this discussion.

1- Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants. by R Sharma, D F Kraemer, R M Torrazza, V Mai, J Neu, J J Shuster, M L Hudak. 

http://www.jpeds.com/article/S0022-3476%2814%2900529-0/abstract

2- Red Blood Cell Transfusion Is Not Associated with Necrotizing Enterocolitis: A Review of Consecutive Transfusions in a Tertiary Neonatal Intensive Care Unit. by Matthew B. Wallenstein, Yassar H. Arain, Krista L. Birnie, Jennifer Andrews, Jonathan P. Palma, William E. Benitz, Valerie Y. Chock.

http://www.nature.com/jp/journal/vaop/ncurrent/full/jp201459a.html

http://www.jpeds.com/article/S0022-3476%2814%2900529-0/abstract

http://www.nature.com/jp/journal/vaop/ncurrent/full/jp201459a.html

I do agree for holding 1-2 feeds, some studies is going on

try to explain the relation between NEC and blood transfusion

Some mentioned that it is the same mechanism as in acute

lung injury post transfusion . Acute GIT injury post transfusion