Packed Red Blood Cell Transfusion Increases Regional Cerebral and Splanchnic Tissue Oxygen Saturation in Anemic Symptomatic Preterm Infants

Bailey, Sean M.; Hendricks‐Muñoz, Karen D.; Wells, John; Mally, Pradeep

doi:10.1055/s-0030-1247598

Cited by 86 publications

(109 citation statements)

References 27 publications

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“…We have shown that blood transfusion in preterm infants increased cerebral tissue oxygenation index (cTOI) as well as cerebral tissue haemoglobin index (cTHI) during the first [8][9][10]38 . In these studies preterm infants of 5 to 93 days of age with a wide range of pre-transfusion Hb were clubbed together as a single group.…”

Section: Discussionmentioning

confidence: 99%

“…The threshold for transfusion in preterm infants remain controversial and has led to several randomised controlled trials using liberal and restrictive thresholds for blood transfusion with conflicting reports on neurological outcomes [5][6][7] . Whether these thresholds were not optimal or whether haemoglobin concentration in the blood does not correlate with tissue oxygenation measurements [8][9][10] remains to be answered.…”

Section: Introductionmentioning

confidence: 99%

“…Cerebral NIRS oximetry has been used in the past to assess the effect of blood transfusion in older stable preterm infants 9,10,35 . But the effect on cerebral perfusion and oximetry in pre-transfusion anaemic state and response to blood transfusion in different gestational and chronological ages remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Banerjee

Leung

Aladangady

2016

Early Human Development

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word count: 400 words (maximum 400) Manuscript body word count: 4057 words (maximum 6000) 2 | P a g e AbstractPreterm infants frequently receive blood transfusion during their stay in neonatal unit, and its impact on organ perfusion and oxygenation is not clear. The aim of the study was to measure the effect of blood transfusion on cerebral blood flow and oxygenation in preterm infants in relation to chronological age.Fifty nine infants were studied: group 1=20, group 2=21 and group 3=18 infants with median age (range) at transfusion of 5 (1-7), 14 (8-27) and 45 (29-68) days respectively. Gestational age and birth weight of infants between groups were similar. Pre-transfusion vital parameters were similar between the groups except the heart rate was significantly higher in group 1 compared to group 3 (p=0.02). The mean BP increased significantly in all three groups and there were no significant changes in other vital parameters following transfusion.There was no change in pre and post transfusion pCO2 and pH in blood gas. The mean pretransfusion Anterior Cerebral artery (ACA) time averaged mean velocity (TAMV) increased significantly with chronological age (p<0.001), and ACA Peak Systolic Velocity (PSV) also increased with chronological age of infants but this was not significant. Pre-transfusion ACA TAMV and PSV decreased significantly (p≤0.04), and there was no change in ACA Resistance Index (RI) and Pulsatility Index (PI) following transfusion in infants of all 3 groups. The pre-transfusion mean Superior Vena Cava (SVC) flow decreased significantly in Group 1 (p=0.03) and Group 3 (p<0.001) following transfusion, but the change was not significant in the Group 2 infants (p=0.16). The mean pre-transfusion cerebral tissue oxygenation index (cTOI) levels were significantly lower in group 3 compared to group 1 (p=0.02). The cerebral tissue haemoglobin level cTHI (p<0.001) and cTOI (p<0.05) increased significantly post-transfusion in all the three groups. The percentage increase in post-transfusion cTOI from baseline was 5%, 11% and 12% in group 1, group 2 and group 3 3 | P a g e infants respectively. On comparing infants with PDA (n=14) to gestational and chronological age matched controls (n=14), there was no significant difference in these measurements.Baseline cTOI decrease and ACA TAMV increase with increasing chronological age. Blood transfusion increased cTOI and cTHI, and decreased ACA TAMV in all age group of infants but the proportion of response is different. PDA had no impact on the baseline cerebral oximetry and blood flow as well as changes following transfusion. Future transfusion trials should take into account the impact of postnatal age on cerebral oximetry and blood flow.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Banerjee

Leung

Aladangady

2016

Early Human Development

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“…It has been used in preterm infants for various healthcare conditions such as respiratory distress syndrome, 7 red blood cell transfusion, 8 desaturations, 9 indomethacin therapy 10,11 or ligation of a patent ductus arteriosus 12,13 and during the critical first days of life. [14][15][16][17] Major determinants of the regional tissue oxygen saturation are changes in SpO 2 , regional perfusion, regional blood volume and metabolic rate of oxygen utilization.…”

Section: Introductionmentioning

confidence: 99%

Brain oxygenation monitoring during neonatal resuscitation of very low birth weight infants

et al. 2011

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Objective: To explore if regional cerebral tissue oxygen saturation monitoring by near-infrared spectroscopy (NIRS) is feasible during neonatal resuscitation of very low birth weight (VLBW) infants after birth.Study Design: Cerebral tissue oxygen saturation was measured by NIRS in 51 VLBW infants (mean gestational age: 27.8 weeks) during the first 10 min after delivery.Result: A regional cerebral tissue oxygen saturation signal was available after a median (interquartile range) age of 52 (44 to 68) s. In three infants the signal was obtained after 10 min of age. After delivery cerebral tissue oxygen saturation rose continuously from 37 (31 to 49) % at 1 minute of age and reached a steady state in the range of 61 to 84% B7 min after birth. Percentiles of cerebral tissue oxygen saturation of this cohort of preterm infants are given. Conclusion:Cerebral tissue oxygen saturation monitoring is feasible during neonatal resuscitation of VLBW infants within the first minutes of life.

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“…Nevertheless, we have limited ways to monitor tissue oxygenation and measure the effect of transfusion. New techniques, under evaluation, may ultimately provide better information on the effect of transfusion [3][4][5]. Near infrared spectroscopy has been applied to monitor cerebral circulation (INVOS system: http://www.…”

Section: Clinical Studies Of O 2 Delivery By Red Cellsmentioning

confidence: 99%

Three respiratory gases and the red cell: oxygen, carbon dioxide and nitric oxide

Dzik

2010

ISBT Science Series

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Three vital gases -oxygen, carbon dioxide and nitrogen -intersect at the level of the human red blood cell. The delivery of oxygen to all tissues by red cells is essential to human life. Evolution has created a complex molecule, haemoglobin, designed for efficient uptake and off-loading of oxygen. Iron rests at the centre of the haeme moiety and is critical for oxygen exchange. Although studied for over a century, some details of oxygen transport by the red cell remain uncertain. Recent research has focused on the interaction of haemoglobin with a complex of cellmembrane proteins centred on band 3. In addition, there is renewed interest in the question of whether or not stored red cells deliver oxygen to tissues as well as fresh red cells. The interactions of CO 2 with the red cell have drawn far less research attention. Plasma CO 2 released by tissues serves as an essential trigger for oxygen release by haemoglobin via the Bohr effect. CO 2 transport depends on conversion of CO 2 to bicarbonate via red cell carbonic anhydrase in conjunction with chloride exchange across the red cell membrane. There is very little research on the effect of blood storage on CO 2 excretion although this aspect of respiratory physiology is every bit as important as oxygen delivery. Nitric oxide (NO) physiology is directly related to oxygen delivery by the red cell. NO serves a local vasodilator to increase blood flow to hypoxic tissue beds. NO binds strongly to haemoglobin which serves as an NO sink. Under normal conditions, plasma NO synthesized by endothelial cells is not consumed by red cell haemoglobin because of a diffusion blockade across the red cell membrane that results from membrane structures not fully identified. Under conditions of red cell lysis, free haemoglobin scavenges NO reducing local vasodilation. Scavenging of NO is now recognized as an important component of the physiologic response to chronic haemolysis and is very likely to play an important role in the renal lesion of acute haemolysis. The three RBC gases are also the three principal gases of the Earth's atmosphere. While CO 2 is the least abundant of the three by far, it is also likely to be the most critical to the future survival of life on Earthbecause small further increases in the concentration of CO 2 will result in continued climate change, and large increases will be deadly. Thus, the management of three vital gases by the collection of red cells found within us has broad similarities to the collective management of our atmosphere. Just as the survival of individual tissue cells depends upon proper balance of these three respiratory gases, so too will their proper balance be the key to survival of life on Earth.The reversible binding of oxygen to haemoglobin is an event vital to the life of many species including humans. Oxygen binds co-operatively to haemoglobin such that oxygenation of one globin chain facilitates oxygenation of the other chains in the haemoglobin tetramer. At the centre

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Packed Red Blood Cell Transfusion Increases Regional Cerebral and Splanchnic Tissue Oxygen Saturation in Anemic Symptomatic Preterm Infants

Cited by 86 publications

References 27 publications

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Brain oxygenation monitoring during neonatal resuscitation of very low birth weight infants

Three respiratory gases and the red cell: oxygen, carbon dioxide and nitric oxide

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