• Packed red cell transfusion
• NEC
• feeds
• Hypoxia
• Gut injury

Necrotising enterocolitis (NEC) is a multifactorial condition, with suspected risk factors, including preterm birth, small for gestational age, hypoxic-ischaemic events, early and rapid advancement of enteral feeds, formula feeds and bacterial overgrowth.1

Development of NEC has been associated with packed red blood cell transfusion (PRBCT) and this has led to controversy over whether feeds should be stopped when transfusions are given. A small study from El Dib et al 2 reported a decreased incidence of NEC following a policy change of withholding feeds during transfusion. Following a small number of cases of NEC occurring within 48 h of a PRBCT on our unit, we decided to evaluate practice regarding enteral feeding during PRBCT across all neonatal units in England.

In March 2011, a postal questionnaire was sent to the lead clinician of each of England's 171 neonatal units. The questionnaire evaluated the unit's practice and written guidance regarding enteral feeding during transfusions.

We received 117 responses—a response rate of 68%. The response rate was similar across level 1, 2 and 3 units (65%, 69% and 69%, respectively).

Enteral feeds were routinely stopped or reduced during PRBCT in 41 (35%) units. Of these 41 units, 37 (90%) stopped feeds entirely. When feeds were stopped or reduced, this was for the duration of the transfusion in most cases (66%), with the remainder of units adjusting feeds for a variable period of time from 4 h before to 4 h after transfusion. There was written guidance on feeding during PRBCT in 25 (21%) units.

It is clear from this small study that the majority of clinicians in English neonatal units do not interrupt enteral feeds during transfusions.