Cardiorespiratory Monitoring of Red Blood Cell Transfusion in Preterm Infants

Abstract

Clinical improvement after red blood cell (RBC) transfusions in preterm infants remains debated. This study aims to investigate the effect of RBC transfusion on the occurrence of desaturations and hypoxia and other cardiorespiratory outcomes in preterm infants. In this longitudinal observational study, prospectively stored cardiorespiratory parameters of preterm infants who received at least one RBC transfusion between July 2016 and June 2017 were analyzed. Sixty infants with 112 RBC transfusions, median GA of 26.7 weeks, were included. The number of desaturations and area <80% SpO2 limit, as a measure of the hypoxic burden, were calculated in 24h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, mean (SE) number of desaturations per hour decreased from 3.28(0.55) to 2.25(0.38; p<0.001) and area <80% SpO2 limit decreased from 0.14(0.04) to 0.08(0.02) %/sec (p=0.02). These outcomes were stratified for number of desaturations in 24h prior to RBC transfusion. The largest effect was observed in the group with the highest mean number of desaturations (≥6) prior to RBC transfusion, with a decrease from 7.50(0.66) to 4.26(0.38) (p<0.001) in number of desaturations and 0.46(0.13) to 0.20(0.06) in area <80% SpO2. Perfusion index increased significantly after RBC transfusion (p<0.001). No other significant effects of RBC transfusion on cardiorespiratory data were observed.Conclusions: RBC transfusions in preterm newborns decrease the incidence of desaturations and the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed.