Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants

Goldstein, Gregory P.; Rao, Anoop; Ling, Albee Y.; Ding, Victoria; Chang, Irene J.; Chock, Valerie Y.

doi:10.1111/trf.15680

Cited by 6 publications

(11 citation statements)

References 32 publications

(74 reference statements)

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“…In preterm infants receiving RBC transfusions according to local protocols, anemia was associated with lower r c SO 2 in most cases (30,39,40,44), but Wardle et al found similar cFTOE between anemic infants and controls (49). In the latter study, however, many babies were transfused based on physician discretion, rather than on the cFTOE cut-off levels mentioned in their study protocol.…”

Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 78%

“…The majority (83%) of the 18 studies that reported on cerebral oxygenation during and after RBC transfusion found r c SO 2 to be higher during and after RBC transfusion compared to pretransfusion levels in anemic preterm infants (7,15,30,34,35,39,(41)(42)(43)(44)(45)(46)(47)(48)(49). Non-significant changes in cerebral oxygen saturation during and after RBC transfusions were observed in 3 studies (32,33,36).…”

Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 98%

“…An explanation for not finding differences between pre-transfusion anemia severity might be the fact that peripheral tissues demonstrate a more robust response than the brain, possibly as a result of the neuroprotective maintenance of cerebral oxygen delivery (37,48). This regulation of oxygen-carrying capacity to the brain might explain the findings of increased r c SO 2 and decreased cFTOE after RBC transfusion irrespective of pre-transfusion anemia severity (30). Another possibility for these findings may be related to the effects of other RBC transfusion strategies, i.e., "booster" transfusions (43).…”

Section: Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 99%

“…In eight studies, the effect of pre-transfusion anemia severity on cerebral oxygenation was taken into account when assessing r c SO 2 and cFTOE after RBC transfusion (7,30,34,39,42,43,45,46). Goldstein et al (30) and Mintzer et al (43) found an increased r c SO 2 and decreased cFTOE irrespective of the pre-transfusion Hb or Ht. All others described a correlation with anemia severity.…”

Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 99%

See 3 more Smart Citations

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

et al. 2021

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Background: Anemia remains a common comorbidity of preterm infants in the neonatal intensive care unit (NICU). Left untreated, severe anemia may adversely affect organ function due to inadequate oxygen supply to meet oxygen requirements, resulting in hypoxic tissue injury, including cerebral tissue. To prevent hypoxic tissue injury, anemia is generally treated with packed red blood cell (RBC) transfusions. Previously published data raise concerns about the impact of anemia on cerebral oxygen delivery and, therefore, on neurodevelopmental outcome (NDO).Objective: To provide a systematic overview of the impact of anemia and RBC transfusions during NICU admission on cerebral oxygenation, measured using near-infrared spectroscopy (NIRS), brain injury and development, and NDO in preterm infants.Data Sources: PubMed, Embase, reference lists.Study Selection: We conducted 3 different searches for English literature between 2000 and 2020; 1 for anemia, RBC transfusions, and cerebral oxygenation, 1 for anemia, RBC transfusions, and brain injury and development, and 1 for anemia, RBC transfusions, and NDO.Data Extraction: Two authors independently screened sources and extracted data. Quality of case-control studies or cohort studies, and RCTs was assessed using either the Newcastle-Ottawa Quality Assessment Scale or the Van Tulder Scale, respectively.Results: Anemia results in decreased oxygen-carrying capacity, worsening the burden of cerebral hypoxia in preterm infants. RBC transfusions increase cerebral oxygenation. Improved brain development may be supported by avoidance of cerebral hypoxia, although restrictive RBC transfusion strategies were associated with better long-term neurodevelopmental outcomes.Conclusions: This review demonstrated that anemia and RBC transfusions were associated with cerebral oxygenation, brain injury and development and NDO in preterm infants. Individualized care regarding RBC transfusions during NICU admission, with attention to cerebral tissue oxygen saturation, seems reasonable and needs further investigation to improve both short-term effects and long-term neurodevelopment of preterm infants.

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Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 78%

Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 98%

Section: Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 99%

Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 99%

See 2 more Smart Citations

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

et al. 2021

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“…Approximately, 50-95% of low birth weight (<1500 g) and 95% of extremely low birth weight (<1000 g) infants receive erythrocyte transfusion (ET) at least once during their stay in neonatal intensive care unit (NICU) after birth (8,9). 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).…”

Section: Introductionmentioning

confidence: 99%

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

YAZICI

Bilgin²,

ÖZCAN>³

et al. 2023

Türkiye Çocuk Hast Derg

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Objective: This study aimed to determine the clinical efficacy of erythrocyte transfusion (ET) in premature infants. Material and Methods: Very low birth weight (VLBW) infants with gestational age (GA) < 32 weeks and/or birth weight (BW) <1500 g and hospitalized in neonatal intensive care unit (NICU) between 2012-2018 were retrospectively evaluated. ET was performed according to Ohls 2007 and Turkish Neonatalogy Society Blood Products Transfusion Guidelines. Results: 72 infants included in this study. Mean BW was 1325 g (680-2290 g), GA was 30 weeks (25-32), median postnatal age was 36.7±26.9 days (8-129), number of ET during hospitalization was 2±1.2 (1-6). There were no significant changes in mean heart rates (p=0.183) and median respiratory rates before and after ET (p=0.123). Weight gain (16 g/day-11 g/day) was statistically similar before and after ET (p=0.861). A significant decrease in apnea, non-invasive ventilation (NIV) and caffeine therapy requirements after ET was determined (p<0.001, p=0.016 and p=0.016). Serum lactate (2.9-1.5) levels were decreased by ET (p=0.017). Conclusion: Premature infants should closely follow-up for anemia and related symptoms during NICU stay. ET may help to decrease frequency of apnea of prematurity, requirements of caffeine therapy and NIV. ET improves tissue oxygenation in VLBW infants with anemia. Decision of ET should be made according to severity of symptoms, and should be performed according to international, national or local transfusion guidelines.

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Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants

Chock,

Kirpalani,

Bell

et al. 2023

JAMA Netw Open

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ImportancePreterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes.ObjectiveTo determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age.Design, Setting, and ParticipantsThis was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022.InterventionsNear-infrared spectroscopy monitoring of Csat and Msat.Main Outcomes and MeasuresPrimary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score &lt;85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment.ResultsA total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower–hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher–hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO2) in either group (0.2% vs −0.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03).Conclusions and RelevanceIn this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO2. Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia.Trial RegistrationClinicalTrials.gov Identifier: NCT01702805

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Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants

Cited by 6 publications

References 32 publications

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

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

Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants

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