Effect of blood transfusions on cerebral haemodynamics in preterm infants

Dani, Carlo; Pezzati, Marco; Martelli, Elena; Prussi, Clara; Bertini, Giovanna; Rubaltelli, F F

doi:10.1111/j.1651-2227.2002.tb02881.x

Cited by 39 publications

(33 citation statements)

References 15 publications

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“…In addition, to better interpret our findings, we studied tissue perfusion by Doppler ultrasound. As expected, and in agreement with previous articles, 8,9 we found that blood transfusions were followed by an increase in cerebral oxygenation (rSO2C). However, we observed that this increase in oxygen delivery was compensated by a decrease in oxygen blood extraction (FOEC): we speculated that this occurs to keep the oxygen consumption of cerebral tissue constant.…”

Section: Discussionsupporting

confidence: 93%

“…From the Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Florence, Italy. spectroscopy (NIRS) in preterm infants has demonstrated that RBC transfusions decrease cerebral blood flow (CBF) velocity [6][7][8] and improve cerebral oxygenation. 8,9 However, the effects of RBC transfusions on the perfusion and oxygenation of other tissues, such as kidneys and gut, have never been investigated.…”

mentioning

confidence: 99%

“…spectroscopy (NIRS) in preterm infants has demonstrated that RBC transfusions decrease cerebral blood flow (CBF) velocity [6][7][8] and improve cerebral oxygenation. 8,9 However, the effects of RBC transfusions on the perfusion and oxygenation of other tissues, such as kidneys and gut, have never been investigated. Recently, a new multichannel NIRS device has offered the clinicians the enticing possibility of measuring regional oxygenation (rSO2) in multiple sites contemporaneously.…”

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confidence: 99%

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Blood transfusions increase cerebral, splanchnic, and renal oxygenation in anemic preterm infants

et al. 2010

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Blood transfusions increase cerebral, splanchnic, and renal oxygenation in anemic preterm infants

et al. 2010

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“…This then probably counteracts the intended increased oxygen transport to the brain. Volume expansion using red blood cells rather than saline would increase hematocrit, and hence increase cerebral oxygen supply, resulting in a decrease of cFTOE, as previously reported in anemic infants [22,23,24]. …”

Section: Discussionmentioning

confidence: 66%

Volume Expansion Does Not Alter Cerebral Tissue Oxygen Extraction in Preterm Infants with Clinical Signs of Poor Perfusion

et al. 2013

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Background: Preterm infants with signs of poor perfusion are often treated with volume expansion, although evidence regarding its effect on cerebral perfusion is lacking. Moreover, the effect is questionable in preterm infants with an adequate cerebrovascular autoregulation (CAR). A useful measure to assess perfusion is cerebral fractional tissue oxygen extraction (cFTOE). Objectives: To assess the effect of volume expansion on cFTOE in preterm infants with signs of poor perfusion. Methods: In this observational study, we assessed cFTOE using near-infrared spectroscopy in preterm infants with signs of poor perfusion before, during and 1 h after volume expansion treatment. Simultaneously, we measured mean arterial blood pressure (MABP). We tested the effect of volume expansion on both cFTOE and MABP, using multi-level analyses. We intended to define a subgroup that responded to volume expansion with an increase in blood pressure and a decrease in cFTOE, suggesting absent CAR. Results: In 14 preterm infants, with a median gestational age of 26.7 weeks (25.0-28.7 weeks) and a median birth weight of 836 g (615-1,290 g), we found a small increase in MABP during (1.4 ± 1.4 mm Hg, p = 0.003) and after (1.8 ± 1.7 mm Hg, p = 0.001) volume expansion, but no change in cFTOE during (-0.19 ± 0.1% p = 0.44) or after (-0.53 ± 0.1% p = 0.34) volume expansion. We were unable to define a subgroup lacking CAR. Conclusions: Cerebral perfusion, as assessed by cFTOE, does not improve in preterm infants with signs of poor perfusion following volume expansion. In these infants, either CAR is present or volume expansion is inadequate to affect cFTOE.

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“…Although there is no clear correlation between haemoglobin concentration and tissue oxygen extraction [62,63], packed-red cell transfusion improves cerebral oxygenation in the anaemic preterm infant [63,64,65]. In addition, a randomised clinical trial has shown that placental-to-foetal transfusion increases rSt O 2 [44], possibly not only due to increased oxygen carrying capacity but also to improved preload.…”

Section: Interventions That Affect Oxygen Delivery To the Brainmentioning

confidence: 99%

The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants

et al. 2013

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Near-infrared spectroscopy-derived regional tissue oxygen saturation of haemoglobin (rStO₂) reflects venous oxygen saturation. If cerebral metabolism is stable, rStO₂ can be used as an estimate of cerebral oxygen delivery. The SafeBoosC phase II randomised clinical trial hypothesises that the burden of hypo- and hyperoxia can be reduced by the combined use of close monitoring of the cerebral rStO₂ and a treatment guideline to correct deviations in rStO₂ outside a predefined target range. Aims: To describe the rationale for and content of this treatment guideline. Methods: Review of the literature and assessment of the quality of evidence and the grade of recommendation for each of the interventions. Results and Conclusions: A clinical intervention algorithm based on the main determinants of cerebral perfusion-oxygenation changes during the first hours after birth was generated. The treatment guideline is presented to assist neonatologists in making decisions in relation to cerebral oximetry readings in preterm infants within the SafeBoosC phase II randomised clinical trial. The evidence grades were relatively low and the guideline cannot be recommended outside a research setting.

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Effect of blood transfusions on cerebral haemodynamics in preterm infants

Cited by 39 publications

References 15 publications

Blood transfusions increase cerebral, splanchnic, and renal oxygenation in anemic preterm infants

Blood transfusions increase cerebral, splanchnic, and renal oxygenation in anemic preterm infants

Volume Expansion Does Not Alter Cerebral Tissue Oxygen Extraction in Preterm Infants with Clinical Signs of Poor Perfusion

The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants

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