Abstract
Background
To examine the impact of PRBC transfusion on pulmonary vascular resistance (PVR), systemic vascular resistance and myocardial function using echocardiography and cerebral and splanchnic tissue oxygenation using near-infrared spectroscopy (NIRS) in premature babies with and without a PDA.
Methods
A prospective observational study of premature infants born <1500 g in receipt of PRBC transfusions beyond 10 days of age. Echocardiography and NIRS monitoring were performed at baseline, during the transfusion and 24 h after transfusion.
Results
Thirty infants with a median gestation of 26.4 [24.8–28.0] weeks were enrolled. Ten infants had a PDA. Following transfusion, a significant decrease in PVR markers occurred in all infants. Right ventricular (RV) function increased following transfusion in the PDA closed group only. Cerebral oxygen saturation increased following transfusion in all infants. Babies in the PDA open group had significantly lower splanchnic oxygen saturations at baseline compared to the PDA closed group which persisted over the study period and were unaltered by transfusion.
Conclusions
PRBC transfusion lowers PVR irrespective of PDA status. Those with a PDA demonstrated a lack of improvement in RV function and splanchnic oxygenation highlighting the impact a PDA has on the neonatal circulation.
Impact
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The presence or absence of the PDA imposes differential effects on splanchnic oxygenation during red blood cell (PRBC) transfusion in the premature population.
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This is the first study to assess the impact of the PDA on splanchnic oxygenation via near-infrared spectroscopy (NIRS) during red blood cell transfusion in premature neonates.
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New insights have been found into the impact of PRBC transfusion on pulmonary vascular resistance, right ventricular function, cerebral and splanchnic oxygenation in the presence and absence of a PDA and emphasises the ongoing impact of ductal patency on gut oxygenation
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Funding
The work received funding from the European Society for Paediatric Research (ESPR) Young Investigator START-UP Award 2019, Health Research Board Ireland [NCHF-2017-005] and The National Children’s Research Centre [D/17/7]. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
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Each author has met the Pediatric Research authorship requirements. A.S. obtained funding for the study, provided administrative, technical, and material support for the study, acquired, analysed and interpreted data and drafted the manuscript. S.A. provided administrative, technical, and material support for the study. E.D. provided critical revision of the manuscript for important intellectual content. A.E.-K. conceptualised and designed the study, obtained funding, provided administrative, technical, and material support for the study, acquired, analysed and interpreted data, performed the statistical analysis, drafted the manuscript and provided critical revision of the manuscript for important intellectual content and study supervision. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Smith, A., Armstrong, S., Dempsey, E. et al. The impact of a PDA on tissue oxygenation and haemodynamics following a blood transfusion in preterm infants. Pediatr Res 93, 1314–1320 (2023). https://doi.org/10.1038/s41390-022-01967-3
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DOI: https://doi.org/10.1038/s41390-022-01967-3
