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喂养方式与早产儿输血相关性坏死性小肠结肠炎的关系。

Feeding Practices and Effects on Transfusion-Associated Necrotizing Enterocolitis in Premature Neonates.

机构信息

University of Pennsylvania, Philadelphia.

出版信息

Adv Neonatal Care. 2021 Oct 1;21(5):356-364. doi: 10.1097/ANC.0000000000000872.

Abstract

BACKGROUND

Red blood cell (RBC) transfusions have been implicated in the development of necrotizing enterocolitis (NEC) in premature infants. Some evidence exists to support that withholding feedings during transfusion reduces the risk of subsequent NEC development.

PURPOSE

To review the most recent literature on this topic to determine best evidence-based practice regarding withholding or not withholding feedings during RBC transfusions.

METHODS/SEARCH STRATEGY: Four databases were searched using keywords and MeSH terms including "necrotizing enterocolitis," "NEC," "NPO," and "transfusion," with specifications limiting the search to articles published in the last 10 years and limiting the population to neonates.

FINDINGS

Four studies did not demonstrate a reduction in transfusion-associated necrotizing enterocolitis (TANEC) with the implementation of feeding protocols during packed red blood cell (PRBC) transfusions. One study concluded that it could not confirm the benefit of withholding feeds during transfusion to reduce the risk of TANEC. A 2020 randomized controlled trial (RCT) found no difference in splanchnic oxygenation when enteral feeds are withheld, continued, or restricted during a PRBC transfusion. Holding feedings during PRBC transfusions did not result in adverse nutritional outcomes.

IMPLICATIONS FOR PRACTICE

To determine best evidence-based practice surrounding feeding protocols during RBC transfusions in very low-birth-weight and premature infants less than 37 weeks' gestation.

IMPLICATIONS FOR RESEARCH

It is recommended that large, multicentered, adequately powered RCTs be conducted in this area. Individual institutions should standardize their practice to improve quality, safety, and patient outcomes.

摘要

背景

输血已被认为与早产儿坏死性小肠结肠炎(NEC)的发生有关。有一些证据表明,在输血过程中停止喂养可以降低随后发生 NEC 的风险。

目的

回顾该主题的最新文献,以确定关于在输血过程中是否停止喂养的最佳循证实践。

方法/搜索策略:使用关键词和 MeSH 术语(包括“坏死性小肠结肠炎”、“NEC”、“NPO”和“输血”)在四个数据库中进行搜索,并指定搜索范围为过去 10 年内发表的文章,将人群限制为新生儿。

发现

四项研究并未表明在实施输血期间的喂养方案时,可减少与输血相关的坏死性小肠结肠炎(TANEC)。一项研究得出结论,无法确认在输血过程中停止喂养以降低 TANEC 风险的益处。2020 年的一项随机对照试验(RCT)发现,在进行 PRBC 输血时,停止、继续或限制肠内喂养对内脏氧合没有影响。在 PRBC 输血期间停止喂养不会导致不良营养结局。

实践意义

为极低出生体重和胎龄小于 37 周的早产儿确定围绕 RBC 输血期间喂养方案的最佳循证实践。

研究意义

建议在该领域进行大型、多中心、充分有力的 RCT。各机构应规范其实践,以提高质量、安全性和患者结局。

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