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Packed red blood cell transfusion increases regional cerebral and splanchnic tissue oxygen saturation in anemic symptomatic preterm infants

Bailey, Sean M; Hendricks-Munoz, Karen D; Wells, John T; Mally, Pradeep
Preterm infants often receive multiple packed red blood cell (PRBC) transfusions that are intended to improve tissue oxygen levels. Near-infrared spectroscopy (NIRS) monitors regional cerebral tissue oxygen saturation (CrSO(2)) and splanchnic tissue oxygen saturation (SrSO(2)). Before such technology can be employed in neonatal transfusion management, it must first be established that transfusions result in an increase in tissue oxygen saturation. This prospective, observational study used NIRS to determine if PRBC transfusions increase the CrSO(2) and SrSO(2) of symptomatic anemic premature neonates. CrSO(2) and SrSO(2) values were compared for 20-minute duration immediately before, during, immediately after, and 12 hours after transfusion. As a secondary objective, CrSO(2) and SrSO(2) values were correlated with hemoglobin (Hgb) levels. One-way analysis of variance and Pearson correlation statistical tests were used for analysis. A statistically significant increase in CrSO(2) and SrSO(2) values were observed after transfusion in the 30 subjects included (CrSO(2): 62.8 +/- 1.6, 65.6 +/- 1.7, 68.0 +/- 1.3, 67.6 +/- 1.4, P < 0.001 and SrSO(2): 41.3 +/- 2.2, 46.7 +/- 3.0, 52.1 +/- 2.8, 48.2 +/- 2.5, P < 0.001). No correlation was found between CrSO(2) or SrSO(2) and Hgb values. NIRS identified increases in CrSO(2) and SrSO(2) in preterm neonates after PRBC transfusions and has the potential to become incorporated into neonatal transfusion management paradigms
PMID: 20099219
ISSN: 1098-8785
CID: 109789

Prevention of intraventricular hemorrhage in preterm infants

Wells JT; Ment LR
Prematurely born infants with intraventricular hemorrhage (IVH) suffer significant morbidity and mortality, particularly those infants with high grade hemorrhage. The more premature infants have a higher incidence, experiencing more severe IVH. Early onset IVH is also likely to be severe and to progress to a higher grade. The etiology of intraventricular hemorrhages is clearly multifactorial, with differing sets of risk factors for early onset and later occurring hemorrhage. Prevention requires multilayered strategies, both prenatal and postnatal. These strategies are discussed in detail, highlighting unresolved controversies. Certain recommendations for prevention can be made. These include efforts to prevent preterm delivery, transfer of high risk mothers to tertiary care centers and antenatal maternal steroid use. Postnatally, the importance of optimal resuscitation and neonatal care practices is stressed, particularly those which minimize cerebral blood flow fluctuation. Postnatal indomethacin use should be considered in most infants. Further investigation of other strategies is necessary, including multicenter randomized trials to further evaluate antenatal pharmacologic agents, as well as the relative efficacy of different modes of delivery. The different risk factors for early onset versus later onset IVH must be more clearly delineated. Most importantly, any strategy must include sustained neurodevelopmental followup
PMID: 7493588
ISSN: 0378-3782
CID: 12741