Withholding feeding during transfusion: Standardization of practice and nutritional outcomes in premature infants.
OBJECTIVE
To evaluate the nutritional impact of a feed-holding guideline during transfusion for infants <32 weeks gestation.


METHODS
A pre-/post-interventional study was conducted after introduction of a guideline to hold feeds during transfusion. Demographic variables in addition to nutritional outcomes were collected on all infants admitted within 48 hours of birth with gestational age <32 weeks. Data was collected during a 6 month period pre-intervention and the 6 month period post-intervention.


RESULTS
There were 145 eligible infants. Mean birth weight and gestational age were similar in both periods. In total, 98 infants received transfusions, and 82 of those had an active feeding order prior to at least one transfusion. Total transfusions per infant and transfusions ordered while an infant had active feeding orders were similar in both periods. Time to full feedings was decreased post-intervention (p <  0.001). Weight at 34 weeks, incidence of second IV placement, additional IV fluid use, and hypoglycemia were similar between groups.Of 593 total transfusions, 207 were ordered while an infant had an active order for enteral nutrition. Pre-intervention, 64% of transfusions had feeds held during transfusion. Post-intervention, 87% of transfusions had feeds held during transfusion. Feeds were held more often (p <  0.001) and for a shorter duration (p = 0.005) in the post-intervention group.


CONCLUSIONS
Implementing a guideline standardizing feeding practices during transfusions in premature infants increases standardization of care and results in decreased variability in practice. Adverse nutritional consequences were not found after the introduction of the routine practice of holding feedings during transfusion in preterm infants.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J
J
Clarke-Pounder
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J
J
Howlett
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J
J
Burnsed
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
P K
PK
Donohue
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
M M
MM
Gilmore
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
S W
SW
Aucott
D004750:Enteral Nutrition / Q000379:methods*; D017707:Erythrocyte Transfusion; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal / Q000379:methods*; D028761:Withholding Treatment / Q000706:statistics & numerical data*
NICU; PRBC transfusion; Premature infant; Standardization of care; nutrition