Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia

Abstract

Background Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with a rise in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH. Study Design and Methods We prospectively enrolled infants less than 30 weeks gestational age. PI and oxygen saturation (SpO2) were monitored with high-resolution pulse oximeters 24 hours pre and post RBC transfusion. Data was analyzed at three postnatal periods, epoch 1: first week of life (1 to 7 days of life), epoch 2: 2 to 4 weeks of life (8 to 28 days of life), and epoch 3: 4 to 8 weeks of life. Results One hundred eighteen transfusions were analyzed. IH measures significantly decreased post transfusion in epochs 2 and 3. PI significantly increased after transfusion, but it did not correlate with the decrease in IH measures. Mechanical ventilation, fraction of inspired oxygen (FiO2), and IH measures influenced the effects on oxygenation. Conclusions RBC transfusion improved IH after the first week of life. The benefit in IH did not correlate with PI increase after transfusion. Pre transfusion respiratory support and IH measures predicted the effect of transfusion on oxygenation.

Neonatal red blood cell transfusion

“…In another study, administration of fluids, and not only transfusion of blood products, decreases apnoea episodes [12]. Episodic drops in oxygen saturation, common in preterm infants, are less frequent after RBC transfusion beyond the first week of life [13]. Data on cardiovascular effects of RBC transfusions are also inconsistent with some reporting no effect of RBC transfusion on cardiac function [14] and others reporting slower cardiac and respiratory rate after transfusion in anaemic neonates [10].…”

Extubation Readiness in Preterm Infants: Evaluating the Role of Monitoring Intermittent Hypoxemia

“…Infants <30 weeks gestational age (GA) were prospectively enrolled upon admission to the neonatal intensive care unit (NICU). High-resolution SpO 2 data were collected (sampling rate: 1 Hz, averaging time: 2 s) and archived as previously described [ 27 ]. Respiratory support and extubation data were retrospectively collected from the medical records.…”

Response to first dose of inhaled albuterol in mechanically ventilated preterm infants

“…This was a secondary analysis of responses to albuterol administration (2 puffs via a 90 mcg metered-dose inhaler (MDI) without an aerochamber spacer) in mechanically ventilated preterm infants from a cohort of infants cared for in the Level IV NICU of University of Kentucky [ 18 , 25 ]. All infants <30 weeks without major congenital anomalies were approached for enrollment after parental consent.…”

“…The current bedside ventilator and monitors may have objective measures to assess β2-AR agonist responders such as airway resistance and intermittent hypoxemia. Intermittent hypoxemia (IH), a decrease in oxygenated hemoglobin (SpO 2 ), has been shown to correlate with responses to therapeutic blood transfusions [ 18 , 19 ], and are associated with later diagnoses of chronic lung disease [ 20 , 21 ], childhood asthma medication use [ 22 ], and mortality [ 23 ]. Continuous pulse oximetry monitoring provides a noninvasive modality for assessing oxygenation in the neonate and is used extensively in most NICUs [ 24 ].…”