Packed red blood cell transfusion in preterm infants

Bellach, Luise; Eigenschink, Michael; Hassanein, Abtin; Savran, Danylo; Salzer, Ulrich; Müllner, Ernst W.; Repa, Andreas; Klebermaß-Schrehof, Katrin; Wisgrill, Lukas; Giordano, Vito; Berger, Angelika

doi:10.1016/s2352-3026(22)00207-1

Cited by 5 publications

(3 citation statements)

References 67 publications

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“…The development of NEC also involves some other common clinical risk factors, such as severe anemia and blood transfusion exposure, and the exploration of its pathogenesis has confirmed the importance of IMφs. Evidence supports the association between RBC transfusion and adverse clinical outcomes, such as NEC, after anemia in preterm infants ( 90 ). However, there is no consensus on whether transfusion-related intestinal injury is caused by severe anemia or RBC transfusion ( 91 , 92 ), which was recently investigated using a neonatal murine model of transfusion-associated NEC.…”

Section: Role Of Imφs In Pathogenesis Of Necmentioning

confidence: 90%

New insights into intestinal macrophages in necrotizing enterocolitis: the multi-functional role and promising therapeutic application

Wei,

Meng,

et al. 2023

Front. Immunol.

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Necrotizing enterocolitis (NEC) is an inflammatory intestinal disease that profoundly affects preterm infants. Currently, the pathogenesis of NEC remains controversial, resulting in limited treatment strategies. The preterm infants are thought to be susceptible to gut inflammatory disorders because of their immature immune system. In early life, intestinal macrophages (IMφs), crucial components of innate immunity, demonstrate functional plasticity and diversity in intestinal development, resistance to pathogens, maintenance of the intestinal barrier, and regulation of gut microbiota. When the stimulations of environmental, dietary, and bacterial factors interrupt the homeostatic processes of IMφs, they will lead to intestinal disease, such as NEC. This review focuses on the IMφs related pathogenesis in NEC, discusses the multi-functional roles and relevant molecular mechanisms of IMφs in preterm infants, and explores promising therapeutic application for NEC.

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Section: Role Of Imφs In Pathogenesis Of Necmentioning

confidence: 90%

New insights into intestinal macrophages in necrotizing enterocolitis: the multi-functional role and promising therapeutic application

Wei,

Meng,

et al. 2023

Front. Immunol.

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“…The etiologies of NEC encompass formula feeding, hypoxia, infection 1 . However, the debate over whether red blood cell (RBC) transfusion is associated with NEC in preterm infants continues to be widely discussed 2 .…”

Section: Introductionmentioning

confidence: 99%

RBC transfusion and necrotizing enterocolitis in very preterm infants: a multicenter observational study

Dang,

Gu,

Jiang

et al. 2024

Sci Rep

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The causal relationship between Packed red blood cell (RBC) transfusion and necrotizing enterocolitis (NEC) remains uncertain. This study aims to provide an exploration of transfusion and NEC in very preterm infants. Using data from the Chinese Neonatal Network cohort study between 2019 and 2021, the analysis focused on very preterm infants (with a birth weight of < 1500 g or a gestational age of < 32 weeks) who developed NEC after receiving transfusions. The time interval between the prior transfusion and NEC was analyzed. An uneven distribution of the time interval implies an association of transfusion and NEC. Additionally, multivariable logistic analysis was conducted to detect the prognosis of defined transfusion-associated NEC(TANEC). Of the 16,494 infants received RBC transfusions, NEC was noted in 1281 (7.7%) cases, including 409 occurred after transfusion. Notably, 36.4% (149/409) of post-transfusion NEC occurred within 2 days after transfusion. The time interval distribution showed a non-normal pattern (Shapiro–Wilk test, W = 0.513, P < 0.001), indicating a possible link between transfusion and NEC. TANEC was defined as NEC occurred within 2 days after transfusion. Infants with TANEC had a higher incidence of death (adjusted OR 1.69; 95% CI 1.08 to 2.64), severe bronchopulmonary dysplasia (adjusted OR 2.03; 95% CI 1.41 to 2.91) and late-onset sepsis (adjusted OR 2.06; 95% CI 1.37 to 3.09) compared with infants without NEC after transfusion. Unevenly high number of NEC cases after RBC transfusions implies transfusion is associated with NEC. TANEC is associated with a poor prognosis. Further research is warranted to enhance our understanding of TANEC.

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“…Interestingly, U-RBC use has been associated with a lower likelihood of developing transfusion-related comorbidities, since its physiological features are closer to a newborn's physiology [3][4][5]. U-RBCs have specific biological features capable of promoting better patient outcomes than those observed for adult RBCs (A-RBCs), namely, bigger erythrocyte size, high foetal haemoglobin concentrations, growth factors (GFs) and cytokine incidence and immunologic cells' performance, among other features, observed between these two blood donor types [6,7]. Using U-RBCs in LBW and ELBW pre-term neonates can help mitigate severe anaemia without depleting foetal haemoglobin since it often takes place after A-RBC transfusions [4].…”

Section: Introductionmentioning

confidence: 99%

Using umbilical cord blood as a source of paediatric packed red blood cells: Processing and quality control

2023

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Background and ObjectivesUmbilical cord blood (UCB) has been used as a source of red blood cells (RBCs) for neonatal/paediatric transfusion purposes. This study adopted two different procedures to obtain umbilical RBC (U‐RBC) to compare its quality control parameters to those of fractionated adult RBC (A‐RBC), for paediatric purposes.Materials and MethodsUCB units (24) were filtered and processed based on two different methods, namely, conventional/manual (P1;n12) and automatic (P2;n12). They were compared to five fractionated A‐RBCs. U‐RBC and A‐RBC were stored for 14 days and had their haematological, biochemical, haemolytic and microbiological parameters analysed at D1, D7 and D14. Cytokines and growth factors (GFs) in residual U‐RBC plasma were measured.ResultsMean volume of processed U‐RBC units was 45 mL for P1 and 39 mL for P2; the mean haematocrit level reached 57% for P1 and 59% for P2. A‐RBC recorded a mean volume of 44 mL. Haematologic and biochemical parameters analysed in U‐RBC and A‐RBC presented similar behaviours during storage time, except for parameter values, which differed between them. Pro‐inflammatory and immunomodulatory cytokines, as well as GFs, were higher in U‐RBC residual plasma than in that A‐RBC.ConclusionUCB can be processed into RBC based on either manual or automated protocols. U‐RBC units met the referenced quality parameters defined for A‐RBC. Some features, mainly the biochemical ones, should be further investigated to help improve quality parameters, with emphasis on differences found in, and particularities of, this material and on recipients of this new transfusion practice.

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Packed red blood cell transfusion in preterm infants

Cited by 5 publications

References 67 publications

New insights into intestinal macrophages in necrotizing enterocolitis: the multi-functional role and promising therapeutic application

New insights into intestinal macrophages in necrotizing enterocolitis: the multi-functional role and promising therapeutic application

RBC transfusion and necrotizing enterocolitis in very preterm infants: a multicenter observational study

Using umbilical cord blood as a source of paediatric packed red blood cells: Processing and quality control

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