Red Blood Cell Transfusions Affect Intestinal and Cerebral Oxygenation Differently in Preterm Infants with and without Subsequent Necrotizing Enterocolitis

Kalteren, Willemien S; Kuik, Sara J; Braeckel, Koenraad N.J.A. Van; Hulscher, Jan B F; Bos, Arend F.; Kooi, Elisabeth M. W.; Laan, Michelle E. van der

doi:10.1055/s-0038-1636532

Cited by 18 publications

(3 citation statements)

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“…The majority (83%) of the 18 studies that reported on cerebral oxygenation during and after RBC transfusion found r c SO 2 to be higher during and after RBC transfusion compared to pretransfusion levels in anemic preterm infants (7,15,30,34,35,39,(41)(42)(43)(44)(45)(46)(47)(48)(49). Non-significant changes in cerebral oxygen saturation during and after RBC transfusions were observed in 3 studies (32,33,36).…”

Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 98%

“…Another explanation is the increased fraction of adult Hb in comparison with before RBC transfusion, thus reducing the fraction of fetal Hb with a shift in dissociation curve (15). Possible explanations for not finding a significant difference in cerebral oxygenation during and after RBC transfusion in several reports, may relate to liberal transfusion thresholds (32), missing r c SO 2 data before RBC transfusions (36), or adequate cerebral autoregulation providing a constant CBF (33).…”

Section: Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 99%

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Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

et al. 2021

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Background: Anemia remains a common comorbidity of preterm infants in the neonatal intensive care unit (NICU). Left untreated, severe anemia may adversely affect organ function due to inadequate oxygen supply to meet oxygen requirements, resulting in hypoxic tissue injury, including cerebral tissue. To prevent hypoxic tissue injury, anemia is generally treated with packed red blood cell (RBC) transfusions. Previously published data raise concerns about the impact of anemia on cerebral oxygen delivery and, therefore, on neurodevelopmental outcome (NDO).Objective: To provide a systematic overview of the impact of anemia and RBC transfusions during NICU admission on cerebral oxygenation, measured using near-infrared spectroscopy (NIRS), brain injury and development, and NDO in preterm infants.Data Sources: PubMed, Embase, reference lists.Study Selection: We conducted 3 different searches for English literature between 2000 and 2020; 1 for anemia, RBC transfusions, and cerebral oxygenation, 1 for anemia, RBC transfusions, and brain injury and development, and 1 for anemia, RBC transfusions, and NDO.Data Extraction: Two authors independently screened sources and extracted data. Quality of case-control studies or cohort studies, and RCTs was assessed using either the Newcastle-Ottawa Quality Assessment Scale or the Van Tulder Scale, respectively.Results: Anemia results in decreased oxygen-carrying capacity, worsening the burden of cerebral hypoxia in preterm infants. RBC transfusions increase cerebral oxygenation. Improved brain development may be supported by avoidance of cerebral hypoxia, although restrictive RBC transfusion strategies were associated with better long-term neurodevelopmental outcomes.Conclusions: This review demonstrated that anemia and RBC transfusions were associated with cerebral oxygenation, brain injury and development and NDO in preterm infants. Individualized care regarding RBC transfusions during NICU admission, with attention to cerebral tissue oxygen saturation, seems reasonable and needs further investigation to improve both short-term effects and long-term neurodevelopment of preterm infants.

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Section: Anemia Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 98%

Section: Rbc Transfusions and Cerebral Oxygenationmentioning

confidence: 99%

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

et al. 2021

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“…Our study found that the higher the red blood cell counts, the higher recovery of sinus rhythm. The reason is that the higher red blood cell counts, the more higher ability to carry oxygen, [25] which is conducive to increasing the tissue oxygen supply, reducing the tissue ischemia and hypoxia. At present, related studies recommend the use of norepinephrine as a booster drug during CPR, [18] because it is more reliable and suitable to control.…”

Section: Discussionmentioning

confidence: 99%

The related factors for the recovery and maintenance time of sinus rhythm in hospitalized patients with cardiopulmonary resuscitation

Wang²,

Zhang³

et al. 2019

Medicine

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Early cerebral and intestinal oxygenation in the risk assessment of necrotizing enterocolitis in preterm infants

Schat

Zoonen

Laan

et al. 2019

Early Human Development

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Red Blood Cell Transfusions Affect Intestinal and Cerebral Oxygenation Differently in Preterm Infants with and without Subsequent Necrotizing Enterocolitis

Abstract: In preterm infants lower rSO, but not rSO, values during and after RBC transfusions are associated with TANEC. Lower rSO and rSO variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC.

Cited by 18 publications

References 31 publications

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

The related factors for the recovery and maintenance time of sinus rhythm in hospitalized patients with cardiopulmonary resuscitation

Early cerebral and intestinal oxygenation in the risk assessment of necrotizing enterocolitis in preterm infants

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