Abstract
Background
The influence of severity of anemia and cardiac output (CO) on cerebral oxygenation (CrSO2) and on the change in CrSO2 following packed red blood cell (PRBC) transfusion in preterm infants has not been evaluated. The objectives of the current study were to evaluate the effect of pre-transfusion hemoglobin (Hb) and CO-weighted oxygen delivery index (ODI) on CrSO2 and on the post-transfusion CrSO2 change.
Methods
Preterm infants of <32 weeks gestational age (GA) receiving PRBC transfusion were enrolled. Infants received 15 ml/kg PRBC over 3 h. CrSO2 by near-infrared spectroscopy and CO by electrical velocimetry were recorded for 1 h pre-ransfusion and post transfusion. ODI was defined as pre-transfusion Hb × CO.
Results
Thirty infants of 26.6 ± 2.0 weeks GA were studied at 19 ± 12 days. Pre-transfusion Hb was 9.8 ± 0.6 g/dl. Pre-transfusion CrSO2 correlated with pre-transfusion ODI (R2 = 0.1528, p = .044) but not with Hb level. The pre-transfusion to post-transfusion CrSO2 change correlated with pre-transfusion ODI (R2 = 0.1764, p = .029) but not with Hb level. CrSO2 increased from 66 ± 6% to 72 ± 7% post transfusion (p < .001), while arterial oxygen saturation, heart rate, and CO did not change.
Conclusion
In these infants, the pre-transfusion ODI was a better indicator of brain oxygenation and its improvement post transfusion than Hb alone. The role of CO and tissue oxygenation monitoring in assessing the need for transfusion should be evaluated.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Whyte, R. & Kirpalani, H. Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. Cochrane Database Syst. Rev. CD000512 (2011). https://doi.org/10.1002/14651858.CD000512.pub2.
Whyte, R. K. et al. Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics 123, 207–213 (2009).
Sandal, G. et al. Assessment of red blood cell transfusion and transfusion duration on cerebral and mesenteric oxygenation using near-infrared spectroscopy in preterm infants with symptomatic anemia. Transfusion 54, 1100–1105 (2014).
Seidel, D. et al. Changes in regional tissue oxygenation saturation and desaturations after red blood cell transfusion in preterm infants. J. Perinatol. 33, 282–287 (2013).
Bailey, S. M. et al. Packed red blood cell transfusion increases regional cerebral and splanchnic tissue oxygen saturation in anemic symptomatic preterm infants. Am. J. Perinatol. 27, 445–453 (2010).
Whitehead, H. V. et al. Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised? J. Perinatol. 38, 1022–1029 (2018).
Alkalay, A. L. et al. Hemodynamic changes in anemic premature infants: are we allowing the hematocrits to fall too low? Pediatrics 112, 838–845 (2003).
Grollmuss, O. & Gonzalez, P. Non-invasive cardiac output measurement in low and very low birth weight infants: a method comparison. Front. Pediatr. 2, 16 (2014).
Osypka, M. J. & Bernstein, D. P. Electrophysiologic principles and theory of stroke volume determination by thoracic electrical bioimpedance. AACN Clin. Issues 10, 385–399 (1999).
van Hoften, J. C. et al. Cerebral tissue oxygen saturation and extraction in preterm infants before and after blood transfusion. Arch. Dis. Child. Fetal Neonatal Ed. 95, F352–F358 (2010).
Pryds, O. & Greisen, G. Effect of PaCO2 and haemoglobin concentration on day to day variation of CBF in preterm neonates. Acta Paediatr. Scand. Suppl. 360, 33–36 (1989).
Song, R. et al. The use of electrical cardiometry for continuous cardiac output monitoring in preterm neonates: a validation study. Am. J. Perinatol. 31, 1105–1110 (2014).
Noori, S. et al. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography. Arch. Dis. Child. Fetal Neonatal Ed. 97, F340–F343 (2012).
Norozi, K. et al. Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br. J. Anaesth. 100, 88–94 (2008).
Blohm, M. E. et al. Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates. J. Clin. Monit. Comput. 31, 589–598 (2017).
Acknowledgments
This work was supported by the University of Miami Project NewBorn. Unrestricted equipment support was provided by Covidien/Medtronic and Cardiotronic/Osypka Medical.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jain, D., D’Ugard, C., Bancalari, E. et al. Cerebral oxygenation in preterm infants receiving transfusion. Pediatr Res 85, 786–789 (2019). https://doi.org/10.1038/s41390-018-0266-7
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41390-018-0266-7
This article is cited by
-
The near-infrared spectroscopy to evaluate neonatal improvement after transfusion: a systematic review and meta-analysis
BMC Pediatrics (2025)
-
A recommendation for the use of electrical biosensing technology in neonatology
Pediatric Research (2025)
-
Early brain and abdominal oxygenation in extremely low birth weight infants
Pediatric Research (2022)
-
Transfusion prevention using erythropoietin, parenteral sucrose iron, and fewer phlebotomies in infants born at ≤30 weeks gestation at a high altitude center: a 10-year experience
Journal of Perinatology (2021)
