Effect of Blood Transfusions on Intermittent Hypoxic Episodes in a Prospective Study of Very Low Birth Weight Infants

Kovatis, Kelley Z; Fiore, Juliann M. Di; Martin, Richard J.; Abbasi, Soraya; Chaundhary, Aasma S.; Hoover, Stephen; Zhang, Zugui; Kirpalani, Haresh

doi:10.1016/j.jpeds.2020.03.015

Cited by 13 publications

(5 citation statements)

References 33 publications

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“…In our study, RBC transfusion had a positive effect on the number of desaturations, especially in those experiencing the most desaturations before transfusion. Similarly, a decrease in intermittent hypoxia and apneas after RBC transfusion was found in previous studies [6,9,28]. However, none of these studies strati ed for the frequency of desaturations before transfusion.…”

Section: Discussionmentioning

confidence: 55%

“…Although some studies found transfusions to be effective in preventing apneas and reducing intermittent hypoxia on the short term, several other studies reported minimal or no effect [5][6][7][8][9][10]. Additionally, retrospective studies found that RBC transfusions in preterm infants were associated with an increased incidence of intra-hospital mortality, intraventricular hemorrhage, and necrotizing enterocolitis [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Cardiorespiratory Monitoring of Red Blood Cell Transfusion in Preterm Infants

Poppe

Essen

Weteringen

et al. 2021

Preprint

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Clinical improvement after red blood cell (RBC) transfusions in preterm infants remains debated. This study aims to investigate the effect of RBC transfusion on the occurrence of desaturations and hypoxia and other cardiorespiratory outcomes in preterm infants. In this longitudinal observational study, prospectively stored cardiorespiratory parameters of preterm infants who received at least one RBC transfusion between July 2016 and June 2017 were analyzed. Sixty infants with 112 RBC transfusions, median GA of 26.7 weeks, were included. The number of desaturations and area <80% SpO2 limit, as a measure of the hypoxic burden, were calculated in 24h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, mean (SE) number of desaturations per hour decreased from 3.28(0.55) to 2.25(0.38; p<0.001) and area <80% SpO2 limit decreased from 0.14(0.04) to 0.08(0.02) %/sec (p=0.02). These outcomes were stratified for number of desaturations in 24h prior to RBC transfusion. The largest effect was observed in the group with the highest mean number of desaturations (≥6) prior to RBC transfusion, with a decrease from 7.50(0.66) to 4.26(0.38) (p<0.001) in number of desaturations and 0.46(0.13) to 0.20(0.06) in area <80% SpO2. Perfusion index increased significantly after RBC transfusion (p<0.001). No other significant effects of RBC transfusion on cardiorespiratory data were observed.Conclusions: RBC transfusions in preterm newborns decrease the incidence of desaturations and the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Cardiorespiratory Monitoring of Red Blood Cell Transfusion in Preterm Infants

Poppe

Essen

Weteringen

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…In our study, RBC transfusion had a positive effect on the number of desaturations, especially in those experiencing the most desaturations before transfusion. Similarly, a decrease in intermittent hypoxia and apneas after RBC transfusion was found in previous studies [6,9,29]. However, none of these studies stratified for the frequency of desaturations before transfusion.…”

Section: Discussionmentioning

confidence: 58%

“…Despite extensive research, the optimal RBC transfusion policy for preterm infants remains unclear [3,4]. Although some studies found transfusions to be effective in preventing apneas and reducing intermittent hypoxia on the short term, several other studies reported minimal or no effect [5][6][7][8][9][10]. Additionally, retrospective studies found that RBC transfusions in preterm infants were associated with an increased incidence of intra-hospital mortality, intraventricular hemorrhage, and necrotizing enterocolitis [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Cardiorespiratory monitoring of red blood cell transfusions in preterm infants

et al. 2021

View full text Add to dashboard Cite

Clinical improvement after red blood cell (RBC) transfusions in preterm infants remains debated. This study aims to investigate the effect of RBC transfusion on the occurrence of desaturations and hypoxia, and other cardiorespiratory outcomes in preterm infants. In this longitudinal observational study, prospectively stored cardiorespiratory parameters of preterm infants who received at least one RBC transfusion between July 2016 and June 2017 were retrospectively analyzed. Sixty infants with 112 RBC transfusions, median GA of 26.7 weeks, were included. The number of desaturations and area < 80% SpO2 limit, as a measure of the hypoxic burden, were calculated in 24 h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, the mean (SE) number of desaturations per hour decreased from 3.28 (0.55) to 2.25 (0.38; p < 0.001), and area < 80% SpO2 limit decreased from 0.14 (0.04) to 0.08 (0.02) %/s (p = 0.02). These outcomes were stratified for the number of desaturations in 24 h prior to RBC transfusion. The largest effect was observed in the group with the highest mean number of desaturations (≥ 6) prior to RBC transfusion, with a decrease from 7.50 (0.66) to 4.26 (0.38) (p < 0.001) in the number of desaturations and 0.46 (0.13) to 0.20 (0.06) in the area < 80% SpO2. Perfusion index increased significantly after RBC transfusion (p < 0.001). No other significant effects of RBC transfusion on cardiorespiratory data were observed.Conclusions: RBC transfusions in preterm newborns could help decrease the incidence of desaturations and the area < 80% SpO2 as a measure of the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed. What is Known:•Red blood cell transfusions potentially prevent hypoxia in anemic preterm infants by increasing the circulatory hemoglobin concentration and improving tissue oxygenation.•There is not a predefined hemoglobin concentration cut-off for the occurrence of symptomatic anemia in preterm infants. What is New:•Oxygen desaturations and hypoxia in anemic preterm infants can be improved by RBC transfusions, especially if more desaturations have occurred before transfusion.•Cardiorespiratory monitor data may help identify infants who will benefit most from red blood cell transfusions.

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“…High-volume or high-rate transfusions may increase the risk of transfusion associated circulatory overload (TACO), a leading cause of transfusion-associated morbidity and mortality in adults 39. Neonatal TACO is poorly defined and the true incidence of this and other transfusion-related lung injuries in neonates is not known; observational studies have shown variable outcomes 37 40–42. However, it should be noted that weight-related volumes transfused to non-bleeding neonates (usually 10–20 mL/kg) are commonly higher than those for adults (typically, 350 mL for packed red cells and 200–300 mL for platelets, which equates to <5 mL/kg for an 80 kg adult) 27 43 44.…”

Section: Discussionmentioning

confidence: 99%

Survey of transfusion practices in preterm infants in Europe

Scrivens

Reibel

Heeger

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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BackgroundPreterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data.MethodsFrom October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries.ResultsResponses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×109/L in non-bleeding infants of GA of <28 weeks, while the 25×109/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs.ConclusionsTransfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice.

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Effect of Blood Transfusions on Intermittent Hypoxic Episodes in a Prospective Study of Very Low Birth Weight Infants

Cited by 13 publications

References 33 publications

Cardiorespiratory Monitoring of Red Blood Cell Transfusion in Preterm Infants

Cardiorespiratory Monitoring of Red Blood Cell Transfusion in Preterm Infants

Cardiorespiratory monitoring of red blood cell transfusions in preterm infants

Survey of transfusion practices in preterm infants in Europe

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