O-040 End-of-life Decision Making – Paediatric Intensivists’ And Nonintensivist Paediatricians’ Attitudes

Abstract

Background and aims Hepcidin, which acts as a negative feedback regulator of iron homeostasis, may in future serve as a non-invasive iron status parameter to monitor iron supplementation in preterm infants. For this, coexisting influencing factors should be taken into account. Our objective was to evaluate in preterm infants whether red blood cell (RBC) transfusions have a short-term effect on hepcidin concentrations in serum (Hep (S) ) and urine (Hep (U) ). Methods Prospective observational study including very preterm infants receiving RBC transfusions. The concentration of the mature, 25 amino-acid form of hepcidin was determined in serum und urine by enzyme-linked immunosorbent assay together with cellular indices before and after RBC transfusion. Results The study was conducted between May 2009 and September 2010 at Tübingen University Hospital. 20 preterm infants born at a mean gestational age of 26.0 (interquartile range: 24.9-27.4) weeks and with a mean postnatal age of 30.8 (interquartile range 29.9-32.1) daysreceived 27 RBC transfusions. When measured shortly after transfusion (mean 10 h), hematocrit values increased from a median of 26.6% (SD 2.8) to 40.9% (SD 3.2; p < 0.0001); Hep (S) also increased (geometric mean: 44.3 ng/mL (95% confidence interval: 30.8-63.8) vs. 58.0 ng/mL (95% confidence interval: 35.7-94.3; p < 0.05) but Hep (U) remained unaffected. Conclusion These data indicate a short-term effect of RBC transfusions on serum hepcidin concentrations in preterm infants. Further longer-term observational studies are needed to understand the dynamics of hepcidin regulation in preterm infants.