bimalc

My interpretation of the GRADE review is to ignore the pooled estimates for the observational studies for sure because of the poor quality. The issue is, as Stefan highlights, confounding by indication. The available RCT data do not support transfusion as increasing risk of NEC. I think the most elegant study to try and better understand what is going on and by-pass the confounding by indication study is the JAMA https://www.ncbi.nlm.nih.gov/pubmed/?term=26934258 where they are able to parse out anemia from transfusion. I am still only a fellow, but I base my transfusion practice vis a vis NEC risk on the RCT data from the GRADE review and this paper highlighting the anemia as the key feature. This conclusion is consistent with the finding in the RCTs of less NEC in the liberal transfusion group because the liberal transfusion group would presumably have less (and likely less severe) anemia.

There are two issues. Can you? Yes. This is quite normal in inborn errors of metabolism for example. Are there improved outcomes? I am not aware of data for the general nicu population however I have seen that carnitine levels rapidly become low if baby is npo. For many babies who are not so sick and will start enteral feeds soon it probably does not matter, but I wonder if there is benefit in prolonged npo especially if baby is critically ill or with cardiac dysfunction