Cardiorespiratory monitoring of red blood cell transfusions 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 retrospectively 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 24 h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, the 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) %/s (p = 0.02). These outcomes were stratified for the number of desaturations in 24 h 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 the number of desaturations and 0.46 (0.13) to 0.20 (0.06) in the 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 could help decrease the incidence of desaturations and the area < 80% SpO2 as a measure of the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed. What is Known:•Red blood cell transfusions potentially prevent hypoxia in anemic preterm infants by increasing the circulatory hemoglobin concentration and improving tissue oxygenation.•There is not a predefined hemoglobin concentration cut-off for the occurrence of symptomatic anemia in preterm infants. What is New:•Oxygen desaturations and hypoxia in anemic preterm infants can be improved by RBC transfusions, especially if more desaturations have occurred before transfusion.•Cardiorespiratory monitor data may help identify infants who will benefit most from red blood cell transfusions.

The Efficacy of Erythrocyte Transfusion in Very Low Birth Weight Infants with Premature Anemia

“…This might be explained by improved tissue oxygenation in central nervous system. There are studies with and without improvement of apnea of prematurity by ET (6,14). We found that HR and RR were not different throughout 72 hours before and after ET.…”

“…Kasat et al (31) noticed that tachycardia was the most sensitive predictor of anemia and ET improved apnea, bradycardia, desaturation, tachycardia and oxygen requirements. In this study, indication for ET was only anemia, determined by routine (2,14,30). Studies stated the less BW and GA, the higher need of ET (28).…”

“…ET administered to 90% of extremely low birth weight and 58% of premature infants with gestational age <32 weeks (10)(11)(12)(13). Tranfusion increases amount of circulating hemoglobin, improves tissue oxygenation, maintains same oxygen level by decreasing cardiac output (10,14). It is also associated with increased morbidity and mortality in infants with bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH) (15)(16)(17)(18).…”

Development of a Web-Based Oxygenation Dashboard for Preterm Neonates: A Quality Improvement Initiative

“…Improved ways to display physiological data trends may stimulate the clinician’s responsiveness in adding or weaning interventions based on the patient’s changing condition [ 20 ]. We already showed that physiological data can reflect the cardiorespiratory effect of red blood cell transfusions and the respiratory effect of doxapram that is used to treat apnea of prematurity, although the clinical impact of these findings need to be further investigated prospectively [ 10 , 21 ]. Vinks et al developed a model-informed and individualized pharmacokinetic profile aiming for enhanced individualized and evidence-based pharmacotherapy, resulting in better clinical efficacy and safety with fewer side effects [ 15 ].…”

Survey of transfusion practices in preterm infants in Europe

“…High-volume or high-rate transfusions may increase the risk of transfusion associated circulatory overload (TACO), a leading cause of transfusion-associated morbidity and mortality in adults 39. Neonatal TACO is poorly defined and the true incidence of this and other transfusion-related lung injuries in neonates is not known; observational studies have shown variable outcomes 37 40–42. However, it should be noted that weight-related volumes transfused to non-bleeding neonates (usually 10–20 mL/kg) are commonly higher than those for adults (typically, 350 mL for packed red cells and 200–300 mL for platelets, which equates to <5 mL/kg for an 80 kg adult) 27 43 44.…”