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Stefan Johansson

NEC and blood transfusions - still makes some concerned

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Check out this blog post by Keith Barrington whether transfusions trigger NEC. Or does anemia.
https://neonatalresearch.org/2019/04/16/do-transfusions-trigger-nec-or-does-anemia/ 

I would say that there are enough clinical research data out there to say that there seems to be NO association. Just check out the PINT trial, the RCT comparing a liberal vs a restrictive Hb level for transfusion in preterm infants. If anything, the more liberally transfused group of infant had less NEC. And read this paper by Patel et al that nicely demonstrates that there seems to be confounding of indication coming into play, i.e. it is not the transfusion but the underlying anemia is the problem.

Despite research findings, this question (whether transfusions "lead to" NEC) is still troubling us. Why so?

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I really liked this blog post! I guess many of us have seen devastating cases of post-transfusion NEC that stay with us  and  therefore add "bias" to our judgements on this topic.

There are still questions though right?

Like the severity of the anaemia (how low do we leave the Hb and is that threshold different for certain babies?), the duration of anaemia (how long do we leave it before we transfuse?) and then,  if the mechanism is a re-perfusion injury post-transfusion, how do we prevent it?!

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On 4/17/2019 at 1:26 AM, Stefan Johansson said:

Check out this blog post by Keith Barrington whether transfusions trigger NEC. Or does anemia.
https://neonatalresearch.org/2019/04/16/do-transfusions-trigger-nec-or-does-anemia/ 

I would say that there are enough clinical research data out there to say that there seems to be NO association. Just check out the PINT trial, the RCT comparing a liberal vs a restrictive Hb level for transfusion in preterm infants. If anything, the more liberally transfused group of infant had less NEC. And read this paper by Patel et al that nicely demonstrates that there seems to be confounding of indication coming into play, i.e. it is not the transfusion but the underlying anemia is the problem.

Despite research findings, this question (whether transfusions "lead to" NEC) is still troubling us. Why so?

Thank you, Stefan, for reminding me of my one major criticism of the PINT trial: They did not include NEC (or at least surgical NEC) in their composite outcome.  

As for why we, as a profession, continue to worry about TANEC, it is mostly recall bias (we all remember the case of NEC shortly after transfusion but we never stop to think of all the transfusions we have given without NEC appearing)

On 4/17/2019 at 7:48 AM, Vicky Payne said:

I really liked this blog post! I guess many of us have seen devastating cases of post-transfusion NEC that stay with us  and  therefore add "bias" to our judgements on this topic.

There are still questions though right?

Like the severity of the anaemia (how low do we leave the Hb and is that threshold different for certain babies?), the duration of anaemia (how long do we leave it before we transfuse?) and then,  if the mechanism is a re-perfusion injury post-transfusion, how do we prevent it?!

I've often wondered if there isn't already enough data out there to answer these questions (or at least get a start).  Supervised learning techniques have advanced sufficient that if you were willing to invest in combining and curating multiple datasets of ELBWs you could probably train a binary classifier to predict risk of NEC with or without transfusion.

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 "Check out this blog post by Keith Barrington whether transfusions trigger NEC. Or does anemia."
https://neonatalresearch.org/2019/04/16/do-transfusions-trigger-nec-or-does-anemia/. Both this blog post and this previous on platelets are very interesting. It le me think how really complex is NEC, every time I look into there is seems to another layer of complexity. The debate and talks on

99 NICU meet give a lots think about.  


.These talks and article on platelets got me thinking. Would  it make any difference it we slow the rate of transfusion of platelet?

On 4/20/2019 at 8:16 PM, bimalc said:

Supervised learning techniques have advanced sufficient that if you were willing to invest in combining and curating multiple datasets of ELBWs you could probably train a binary classifier to predict risk of NEC with or without transfusion. 

 

 

NEC can cause premmies to become unwell and be even,transfer several times.
TANEC can terribly and disheartening consequences , which indeed leaves and on impact on clinicians.bimalc  idea quote above is a good one that could give a guidance together with clinicians expertise on who get NEC or Not .

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