TY - JOUR
T1 - Regional tissue oxygenation and conventional indicators of red blood cell transfusion in anaemic preterm infants
AU - Balegar V, Kiran Kumar
AU - Low, Gary KK
AU - Nanan, Ralph KH
N1 - Funding Information:
We acknowledge the faculty of the School of Biomedical Engineering and the Charles Perkins center, The University of Sydney for their assistance in data extraction and processing. We thank all the medical and nursing staff and parents of Nepean Hospital for their assistance in conducting the study. Initials of the authors who received each award – Kiran Kumar Balegar Virupakshappa. Grant numbers awarded to the author – 12/191202.
Publisher Copyright:
© 2022 The Authors
PY - 2022/4
Y1 - 2022/4
N2 - Background: It is unresolved whether low haemoglobin (Hb) and symptoms of anaemia reflect oxygen delivery-consumption imbalances (fractional tissue oxygen extraction [FTOE]). Here, we test whether pre-transfusion Hb and symptoms of anaemia correlate with pre-transfusion cerebral and splanchnic FTOE. Methods: This prospective cohort study was carried out between Sept 1, 2014 and Nov 30, 2016 at Nepean Hospital, Sydney, Australia. The study enroled haemodynamically stable preterm infants: gestation <32 weeks; birth weight <1500 gs; postmenstrual age <37weeks, who received 15 mL/kg packed red blood cell transfusion (PRBCT) based on low Hb and symptoms of anaemia. FTOE was determined using simultaneous monitoring of near-infrared spectroscopy and pulse oximetry for 4 h before PRBCT. Findings: The study enroled 29 infants born with a median gestation of 26.4 weeks (IQR 25.4–28.1), birth weight 922 g (655–1064), at postmenstrual age 33.6 weeks (31.7–34.9), and weight 1487 g (1110–1785). There was no significant correlation between Hb (median 97 g/L, IQR 87–100) and cerebral FTOE (r=–0.12, 95% CI –0.47 to 0.27; p = 0.54, n = 29) as well as splanchnic FTOE (r=–0.09, 95% CI –0.45 to 0.29; p = 0.64, n = 29). Median cerebral FTOE (p = 0.67) and splanchnic FTOE (p = 0.53) did not differ between symptomatic and asymptomatic groups. Interpretation: Our preliminary findings suggest that pre-transfusion Hb and symptoms of anaemia might not accurately reflect oxygen delivery-consumption imbalances in both the brain and the gut. A lack of correlation with cerebral FTOE might be presumed to be due to the brain-sparing effect. However, the lack of correlation with splanchnic FTOE is more concerning. Hence, these results warrant larger studies incorporating FTOE along with the conventional criteria in the transfusion algorithm. Funding: The study was funded (for the purchase of NIRS sensors) by the Australian Women and Children's Research Foundation.
AB - Background: It is unresolved whether low haemoglobin (Hb) and symptoms of anaemia reflect oxygen delivery-consumption imbalances (fractional tissue oxygen extraction [FTOE]). Here, we test whether pre-transfusion Hb and symptoms of anaemia correlate with pre-transfusion cerebral and splanchnic FTOE. Methods: This prospective cohort study was carried out between Sept 1, 2014 and Nov 30, 2016 at Nepean Hospital, Sydney, Australia. The study enroled haemodynamically stable preterm infants: gestation <32 weeks; birth weight <1500 gs; postmenstrual age <37weeks, who received 15 mL/kg packed red blood cell transfusion (PRBCT) based on low Hb and symptoms of anaemia. FTOE was determined using simultaneous monitoring of near-infrared spectroscopy and pulse oximetry for 4 h before PRBCT. Findings: The study enroled 29 infants born with a median gestation of 26.4 weeks (IQR 25.4–28.1), birth weight 922 g (655–1064), at postmenstrual age 33.6 weeks (31.7–34.9), and weight 1487 g (1110–1785). There was no significant correlation between Hb (median 97 g/L, IQR 87–100) and cerebral FTOE (r=–0.12, 95% CI –0.47 to 0.27; p = 0.54, n = 29) as well as splanchnic FTOE (r=–0.09, 95% CI –0.45 to 0.29; p = 0.64, n = 29). Median cerebral FTOE (p = 0.67) and splanchnic FTOE (p = 0.53) did not differ between symptomatic and asymptomatic groups. Interpretation: Our preliminary findings suggest that pre-transfusion Hb and symptoms of anaemia might not accurately reflect oxygen delivery-consumption imbalances in both the brain and the gut. A lack of correlation with cerebral FTOE might be presumed to be due to the brain-sparing effect. However, the lack of correlation with splanchnic FTOE is more concerning. Hence, these results warrant larger studies incorporating FTOE along with the conventional criteria in the transfusion algorithm. Funding: The study was funded (for the purchase of NIRS sensors) by the Australian Women and Children's Research Foundation.
KW - Anaemia
KW - Fractional tissue oxygen extraction
KW - Haemoglobin
KW - Packed red blood cell transfusions
KW - Preterm
UR - http://www.scopus.com/inward/record.url?scp=85127321002&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2022.101365
DO - 10.1016/j.eclinm.2022.101365
M3 - Article
AN - SCOPUS:85127321002
SN - 2589-5370
VL - 46
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 101365
ER -