What is your unit's policy with regards to making babies NPO for blood transfusions?
I recently transferred to a level III NICU. For the two years prior to my arrival, our unit would make babies NPO (starting or increasing IV fluid) for two hours prior to blood, transfuse, and keep NPO two hours after completion. Our neos compared the unit's data from this period to years prior and saw no change in NEC incidence but an increase in hypoglycemic episodes.
Because of this, they decided to go back to the old way of continuing feeds throughout the transfusion. This was right when I began working in the unit. Within a couple months we've had three babies die from NEC -- all PRBC transfused within the past 24 hours, all previously fed breast milk exclusively, all ex-24 weekers.
I thought keeping kids NPO was standard practice. From what I can tell, evidence points pretty strongly to the existence of TANEC, as well as its high(er) rate of mortality than NEC that's not transfusion associated. I am frankly surprised that two years worth of data from our little 40 bed unit is being valued over many years of research in academic settings and some of the meta analyses that come up at the top of every search.
Is there something I'm overlooking? It's not like I want my babies to experience hypoglycemia, but a bolus or some tweaking of IVF seems a whole lot less dire than NEC. Looking for input. Like I said, I'm pretty new to this.
