Effects of red cell transfusion on pulmonary blood flow and right ventricular systolic time intervals in neonates

Nelle, Mathias; Hoecker, Christina; Linderkamp, Otwin

doi:10.1007/s004310050661

Cited by 12 publications

(7 citation statements)

References 13 publications

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“…From a hemodynamic point of view, markers of higher pulmonary vascular resistance, such as more elevated pulmonary artery systolic pressure or a persistent notched left pulmonary arterial flow pattern [13] , were no longer observed after transfusion. Thus, with regard to respiratory status and right ventricular function, RBCT appeared to be as safe as when performed after the 1st postnatal month [20] .…”

Section: Discussionmentioning

confidence: 99%

Myocardial Adaptation to Anemia and Red Blood Cell Transfusion in Premature Infants Requiring Ventilation Support in the 1st Postnatal Week

Cambonie

Matecki²,

Milési³

et al. 2007

Neonatology

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Background: Although transfusion practice in very premature infants is becoming more restrictive, little is known about myocardial adaptation to anemia during the 1st postnatal week. Objectives: To determine the central hemodynamic effects of anemia and red blood cell transfusion in very preterm infants undergoing intensive care. Methods: Twenty-nine neonates of less than 30 weeks gestational age were treated for respiratory distress syndrome, following a strict protocol. Echocardiographies were performed at the 4th and 6th postnatal days, which corresponded to, respectively, just before and 48 h after an erythrocyte transfusion of 15 ml/kg in the 12 anemic infants. Results: Anemic infants had increased stroke volume [2.1 (1.8–2.3) vs. 1.5 (1.3–1.6) ml/kg] and left ventricular (LV) output [312 (271–345) vs. 206 (177–240) ml/min/kg]. The relationship of the heart rate-corrected velocity of circumferential fiber shortening to LV end-systolic meridional wall stress indicated a higher contractile state in the anemic infants, with a higher y-intercept (p = 0.03) and a steeper slope (p = 0.05) of the regression line than in the nonanemic patients. Posttransfusion, the stroke volume, LV output, shortening fraction, and contractile state decreased to the values observed in the nonanemic infants. Conclusions: Myocardial contractility was a major component of the circulatory adjustments in the anemic premature infants requiring ventilation support in the early neonatal period. Changes in LV performance associated with anemia were reversed by transfusion with no detrimental effect on right ventricular function, LV preload or the respiratory status of these patients.

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Section: Discussionmentioning

confidence: 99%

Myocardial Adaptation to Anemia and Red Blood Cell Transfusion in Premature Infants Requiring Ventilation Support in the 1st Postnatal Week

Cambonie

Matecki²,

Milési³

et al. 2007

Neonatology

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“…Neonatal RBCs therefore do not possess specific properties that influence blood viscosity (17). Opposite to exchanging neonatal RBCs with adult RBCs, transfusing anemic preterm infants does increase blood viscosity by 33% and also blood volume (18).…”

Section: Discussionmentioning

confidence: 99%

Blood Transfusion Increases Functional Capillary Density in the Skin of Anemic Preterm Infants

2004

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Direct visualization of the microcirculation at the level of the skin capillaries may provide information on the quality of tissue perfusion. Orthogonal polarization spectral imaging (OPS) enables noninvasively direct observation of those blood vessels. OPS was applied to the upper arm of 13 preterm anemic infants [median (95% confidence interval) gestational age: 26 wk (25-26 wk); birth weight: 730 g (652-789 g)] before and 2 and 24 h after transfusion (Tx). OPS images of skin perfusion were continuously recorded on video. Off-line quantitative data of microvascular perfusion were obtained by measuring functional capillary density, vessel diameter, red blood cell velocity, and flow. We found a significant increase in functional capillary density 2 h after transfusion with an additional significant rise after 24 h [before: 142 (134 -155); 2 h after ; 24 h after Tx: 206 (185-219) cm/cm 2 ; p Ͻ 0.001), thus indicating improved microvascular perfusion. Vessel diameter, red blood cell velocity, and flow did not change significantly. There were no significant changes in clinical variables, such as blood pressure, heart rate, or body temperature. Whereas conventional monitoring methods did not show any changes after transfusion, quantitative analyses of OPS images indicated improved perfusion; hence, it seems a useful monitor for assessing the response to therapies aimed to improve tissue perfusion. Transfusion practices for neonates are controversial, variable, and based on limited scientific information. This inconsistent approach stems from incomplete knowledge of the effects of anemia in infants and a lack of controlled studies. This results in no clearly established indications for transfusions (Txs) in neonates. The decision to transfuse is frequently based on clinical signs, such as episodes of apnea and bradycardia or failure to gain weight. Data on the effects of blood Tx on these clinical parameters, however, are conflicting (1,2). Peripheral fractional oxygen extraction may be a better indicator for the need of Tx. This concept, however, did not seem applicable in the clinical setting, because in a pilot study of anemic infants, indication for Tx was not influenced by the fractional oxygen extraction value (3).The effect of hemodilution on capillary perfusion has been investigated extensively in the hamster skinfold model using intravital microscopy (4 -7). Orthogonal polarization spectral imaging (OPS) has been developed as a noninvasive technique to investigate the human microvasculature and can be used even in small infants (8). The technology has been described in detail elsewhere (9). In brief, through the use of special optics, a virtual light source is created within the tissue and the light is absorbed by Hb, yielding an image of the illuminated Hb-carrying structures in negative contrast. We have previously shown that microvessel diameter, red blood cell velocity (RBC vel), and functional vessel density can be measured noninvasively by OPS in the skin of term and preterm infants (8). The aim of the...

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“…Little is known about the short-term cardiorespiratory effects of transfusions in normotensive preterm infants during the early neonatal period. Previous studies on the effects of 10-20 ml/kg red cell transfusions have been performed after the neonatal period in anaemic infants [1,2,4,8,9,13,14,26]. A decrease in cardiac output has been observed in some studies [8,13], whereas others have reported no significant effect on cardiac output [1,2,4].…”

Section: Discussionmentioning

confidence: 93%

“…A decrease in cardiac output has been observed in some studies [8,13], whereas others have reported no significant effect on cardiac output [1,2,4]. Nelle et al [14] reported no change in non-invasively measured blood pressure. A decrease in HR after red cell transfusion has been more consistently reported in anaemic subjects [8,9,13,14,26], most probably explained by mitigation of tissue hypoxia and concomitant tachycardia [27].…”

Section: Discussionmentioning

confidence: 95%

“…Nelle et al [14] reported no change in non-invasively measured blood pressure. A decrease in HR after red cell transfusion has been more consistently reported in anaemic subjects [8,9,13,14,26], most probably explained by mitigation of tissue hypoxia and concomitant tachycardia [27]. We observed a similar, albeit statistically non-significant ( P =0.062), trend towards decreased HR after the transfusion during the early neonatal period, although the infants in the present study were not anaemic.…”

Section: Discussionmentioning

confidence: 98%

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Haemodynamic effects of erythrocyte transfusion in preterm infants

2004

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Effects of red cell transfusion on pulmonary blood flow and right ventricular systolic time intervals in neonates

Abstract: These results suggest that neither pulmonary artery pressure nor right ventricular function changed as a result of transfusion in spite of rising blood volume and blood viscosity.

Cited by 12 publications

References 13 publications

Myocardial Adaptation to Anemia and Red Blood Cell Transfusion in Premature Infants Requiring Ventilation Support in the 1st Postnatal Week

Myocardial Adaptation to Anemia and Red Blood Cell Transfusion in Premature Infants Requiring Ventilation Support in the 1st Postnatal Week

Blood Transfusion Increases Functional Capillary Density in the Skin of Anemic Preterm Infants

Haemodynamic effects of erythrocyte transfusion in preterm infants

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