Hemodynamic Changes in Anemic Premature Infants: Are We Allowing the Hematocrits to Fall Too Low?

Alkalay, Arie L.; Galvis, Sharon; Ferry, David A.; Simmons, Charles F.; Krueger, Richard C.

doi:10.1542/peds.112.4.838

Cited by 72 publications

(46 citation statements)

References 30 publications

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“…We have also demonstrated for the first time that the SVC blood flow volume decreases following blood transfusion during the first week of life and in the infants who were more than 4 weeks of age. A previous study has shown that anaemic preterm infants develop a high cardiac output state and this decrease significantly on blood transfusion 24 . There was no change in the SVC flow in the Group 2 infants perhaps indicating a more stable cardiovascular state or blood being transfused at a higher baseline Hb level before any haemodynamic decompensation.…”

Section: Discussionmentioning

confidence: 92%

“…Other measures such as continuous measurement of cardiac output in paediatrics and neonates using transthoracic electrical bioimpedence is still in its early stage of validation and development 23 . It has been reported earlier that anaemic stable preterm infants could be at a clinically unrecognised high cardiac output state, which could lead to reduced oxygen delivery to brain 24 . This might in turn lead to cerebral haemorrhage and brain injury 25 .…”

Section: Introductionmentioning

confidence: 99%

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Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Banerjee

Leung

Aladangady

2016

Early Human Development

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word count: 400 words (maximum 400) Manuscript body word count: 4057 words (maximum 6000) 2 | P a g e AbstractPreterm infants frequently receive blood transfusion during their stay in neonatal unit, and its impact on organ perfusion and oxygenation is not clear. The aim of the study was to measure the effect of blood transfusion on cerebral blood flow and oxygenation in preterm infants in relation to chronological age.Fifty nine infants were studied: group 1=20, group 2=21 and group 3=18 infants with median age (range) at transfusion of 5 (1-7), 14 (8-27) and 45 (29-68) days respectively. Gestational age and birth weight of infants between groups were similar. Pre-transfusion vital parameters were similar between the groups except the heart rate was significantly higher in group 1 compared to group 3 (p=0.02). The mean BP increased significantly in all three groups and there were no significant changes in other vital parameters following transfusion.There was no change in pre and post transfusion pCO2 and pH in blood gas. The mean pretransfusion Anterior Cerebral artery (ACA) time averaged mean velocity (TAMV) increased significantly with chronological age (p<0.001), and ACA Peak Systolic Velocity (PSV) also increased with chronological age of infants but this was not significant. Pre-transfusion ACA TAMV and PSV decreased significantly (p≤0.04), and there was no change in ACA Resistance Index (RI) and Pulsatility Index (PI) following transfusion in infants of all 3 groups. The pre-transfusion mean Superior Vena Cava (SVC) flow decreased significantly in Group 1 (p=0.03) and Group 3 (p<0.001) following transfusion, but the change was not significant in the Group 2 infants (p=0.16). The mean pre-transfusion cerebral tissue oxygenation index (cTOI) levels were significantly lower in group 3 compared to group 1 (p=0.02). The cerebral tissue haemoglobin level cTHI (p<0.001) and cTOI (p<0.05) increased significantly post-transfusion in all the three groups. The percentage increase in post-transfusion cTOI from baseline was 5%, 11% and 12% in group 1, group 2 and group 3 3 | P a g e infants respectively. On comparing infants with PDA (n=14) to gestational and chronological age matched controls (n=14), there was no significant difference in these measurements.Baseline cTOI decrease and ACA TAMV increase with increasing chronological age. Blood transfusion increased cTOI and cTHI, and decreased ACA TAMV in all age group of infants but the proportion of response is different. PDA had no impact on the baseline cerebral oximetry and blood flow as well as changes following transfusion. Future transfusion trials should take into account the impact of postnatal age on cerebral oximetry and blood flow.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Banerjee

Leung

Aladangady

2016

Early Human Development

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“…Similarly, Nelle et al [28] ( n = 33) also noticed a significant drop in heart rate (from 161 to 149 beats per min; p = 0.005) following RCBT [28]. Contrastingly Dani et al [29] ( n = 14) and Alkalay et al [30] ( n = 32) found no difference in heart rate following RBCT. However, it was subsequently demonstrated that heart rate correlates positively with the measured blood volume of preterm infants born at 24–32 weeks of gestation [31].…”

Section: Physiological Adaptive Response To Anaemia and Blood Transfumentioning

confidence: 95%

Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies

2018

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The current evidence regarding the indication, advantages and risks of red blood cell transfusion (RBCT) for preterm infants is discussed. This is an important area in Neonatology to be examined given that 90% of extremely low birth weight infants receive RBCT and many controversies remain regarding when to transfuse and the risks of RBCT. The various treatment thresholds and guidelines used are presented and we compare the short-term clinical benefits of liberal and restrictive RBCT in preterm infants; the majority of these are equivocal and sadly long-term outcome data is limited. The latest evidence on how anaemia and blood transfusion affect organ perfusion in preterm infants is presented. This is important when trying to establish the optimal trigger threshold for RBCT in preterm infants, especially because the knowledge about the adaptive physiological responses to anaemia in very low birth weight infants and the effects of RBCT at various levels of anaemia is also inadequate. Further research into the physiological adaptive response to anaemia of varying degrees and to RBCT at different levels of anaemia in preterm infants of different gestational and post-natal ages is needed before we can conclusively guide the optimal timing and trigger thresholds for RBCT in preterm infants.

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“…[9][10][11][12] Anemia prematuritas terjadi pada bayi berat badan lahir rendah 1 sampai 3 bulan setelah lahir dengan kadar hemoglobin di bawah 7 mg/dL. Derajat anemia dan kadar hemoglobin tergantung dari derajat prematuritas.…”

Section: Penggunaan Eritropoetin Pada Anemia Prematuritasunclassified

Peran Eritropoetin pada Anemia Prematuritas

Sartika

Retayasa

Kardana

et al. 2016

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Eritropoetin merupakan molekul glikoprotein yang terdiri dari 165 asam amino dan 4 gugus karbohidrat dengan berat molekul sekitar 34 k dalton. Peran eritropoetin dalam produksi sel darah merah melalui meningkatkan survival, proliferasi dan diferensiasi dari progenitor eritroid pada sumsum tulang. Eritropoetin berikatan dengan reseptor selanjutnya terjadi aktivasi ras/mitogen intraselular yang berperan dalam proliferasi sel. Regulasi produksi eritropoetin adalah peran dari hypoxia-inducible transcription factor-1 (HIF-1). Pada bayi yang lahir prematur terjadi penurunan kadar Hb yang berlebihan dibandingkan dengan bayi cukup bulan. Banyak faktor yang mempengaruhi anemia prematuritas, salah satu di antaranya adalah kurang respon eritropoetin terhadap penurunan kadar Hb. Penggunaan eritropoetin rekombinan mengurangi frekuensi transfusi darah dan meningkatkan retikulosit dengan cepat. Eritropoetin rekombinan belum merupakan standar pengobatan anemia prematuritas secara universal (Sari Pediatri 2008;9(6):375-80). Eritropoetin merupakan faktor pertumbuhan hematopoetik pertama yang dapat dibuat, yaitu eritropoetin rekombinan (epoetin alfa).4 Bersama dengan kemajuan teknologi DNA, eritropoetin rekombinan yang baru telah ditemukan yaitu Darbepoetin-α (NESP). Darbepoetin-α sedikit berbeda dengan eritropoetin aslinya. Darbepoetin-α memiliki berat molekul 38,5 k dalton, 5 rantai ikatan dengan oligosakarida dibandingkan 3 rantai oligosakarida pada eritropoetin aslinya, total karbohidrat 52% dibandingkan 40% pada eritropoetin yang asli, mempunyai waktu paruh yang lebih panjang yaitu sekitar 48,8 jam dibandingkan 12-48 jam pada pemberian secara subkutan. Sedangkan ikatan reseptor pada tempat bekerja eritropoetin sama dengan eritropoetin asli. 2Pada tikus diperlukan sekitar 0,4 IU eritropoetin perhari untuk mempertahankan pruduksi sel darah merah, sedangkan pada manusia belum diketahui. Pada anemia atau hipoksia terjadi peningkatan kadar

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Hemodynamic Changes in Anemic Premature Infants: Are We Allowing the Hematocrits to Fall Too Low?

Cited by 72 publications

References 30 publications

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies

Peran Eritropoetin pada Anemia Prematuritas

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