Impact of Enteral Feeding on Cerebral and Splanchnic Oxygenation During Packed Red Blood Cell Transfusion in Preterm Infants: A Randomised Controlled Trial.

Objective: To investigate the impact of enteral feeding during packed red blood cell transfusion (PRBCT) on splanchnic and cerebral regional oxygenation (sRSO2, cRSO2) in very-low-birthweight (VLBW) neonates.

Study design: Randomised controlled study. Place and Duration of the Study: Department of Neonatology, Faculty of Medicine, Akdeniz University, Antalya, Turkiye, from June 2021 to June 2024.

Methodology: Fifty-six VLBW neonates were categorised into No-feeding and Feeding groups. sRSO2, cRSO2, the ratio of sRSO2 to cRSO2 (SCOR), splanchnic and cerebral fractionated tissue oxygen extraction (sFTOE, cFTOE) were measured at predetermined intervals using near-infrared spectroscopy. Bonferroni-corrected linear mixed models were used to assess repeatedly measured variables across different time points.

Results: An overall increase in sRSO2 and cRSO2 was observed during the study. In contrast to a steady sRSO2 incline in the No-feeding group, the Feeding group exhibited a temporary reduction in sRSO2 and SCOR, followed by an increase in sFTOE during the first hour of PRBCT (∆Mean = -1.958, ∆Mean = -0.024, ∆Mean = 2.088, respectively). Despite the changing patterns in splanchnic oxygenation, the mean differences in sRSO2 and sFTOE between the two groups were -0.67 (95% CI: -2.74 - 1.40, p = 0.520) and 0.83 (95% CI: -1.46 -3.12, p = 0.473), indicating the impact of enteral feeding on sRSO2 was insignificant.

Conclusion: The findings demonstrated improved outcomes in both cerebral and splanchnic oxygenation during PRBCT in stable preterm infants, despite a temporary impairment in splanchnic tissue oxygen utilisation in the Feeding group. Enteral feeding alone did not pose a risk for transfusion-associated necrotising enterocolitis (TANEC). Large-scale studies are warranted to clarify the complex interplay between enteral feeding, transfusion, and tissue oxygenation.

Key words: Blood transfusion, Enteral feeding, Preterm infants, Very-low-birthweight infants, Splanchnic regional oxygenation, Cerebral regional oxygenation, Transfusion-associated necrotising enterocolitis.