Regional tissue oxygenation and conventional indicators of red blood cell transfusion in anaemic preterm infants

Balegar, Kiran Kumar; Low, Gary Kim Kuan; Nanan, Ralph Kh

doi:10.1016/j.eclinm.2022.101365

Cited by 8 publications

(10 citation statements)

References 48 publications

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“…Mintzer et al found reduction in FTOE in splanchnic, renal and cerebral circulation following transfusion and suggested FTOE may be a more sensitive marker of anemia in neonates [11]. Several other studies support this including an observational study by Santal et al [15] although others reported a lack of correlation of FTOE and anaemia [16].…”

Section: Discussionmentioning

confidence: 95%

Abdominal Near Infrared Spectroscopy can be reliably used to measure splanchnic oxygenation changes in preterm infants

et al. 2022

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Objective Near-infrared spectroscopy (NIRS) allows assessment of regional tissue oxygen delivery and extraction. There are doubts regarding reliability of gut NIRS measurements. This study assesses reliability of NIRS for monitoring gut oxygenation. Study design Splanchnic tissue haemoglobin index (sTHI), tissue oxygenation index (sTOI) and fractional tissue oxygen extraction (sFTOE) changes during blood transfusion were measured using NIRS and compared to stable control infants. Infants were grouped into 3 chronological age groups: 1–7, 8–28 and ≥29 days of life. Results sTHI, sTOI significantly increased, and sFTOE reduced following blood transfusion in all age group infants (n = 59), with no changes seen in control infants (n = 12). Baseline characteristics including gestational age and feed volumes did not differ between groups. Conclusion Gut perfusion measured by NIRS improved in infants who received blood transfusion, a change not seen in the control group, thus suggesting NIRS is a reliable method to measure splanchnic tissue oxygenation.

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Section: Discussionmentioning

confidence: 95%

Abdominal Near Infrared Spectroscopy can be reliably used to measure splanchnic oxygenation changes in preterm infants

et al. 2022

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“…Nature and volume of feeding and total fluid intake remained unaltered during the entire study period. A detailed protocol has also been published elsewhere 19–21 …”

Section: Methodsmentioning

confidence: 99%

Splanchnic‐cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants

Balegar

Jayawardhana

Chazal

et al. 2022

Transfusion Medicine

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Background: Splanchnic-cerebral oxygenation ratio (SCOR), the ratio of splanchnic tissue oxygen (StO 2 s) to simultaneously measured cerebral tissue oxygen (StO 2 c), has been described as a surrogate to detect impaired splanchnic oxygenation associated with hypoperfusion status such as necrotizing enterocolitis. This concept is based on the presumption that any change in SCOR indicates a corresponding change in splanchnic tissue oxygenation as the numerator, whereas cerebral tissue oxygenation as the denominator remains stable. However, it is questionable to utilise this concept to detect splanchnic oxygenation changes in the context of packed red blood cell transfusion (PRBCT).Aim: The current study examines the contribution of both cerebral and splanchnic oxygenation components to PRBCT-associated SCOR changes in preterm infants.Design: Prospective cohort study.Setting: Neonatal intensive care.Patients: Hemodynamically stable infants: Gestation <32 weeks; birth weight <1500 g; postmenstrual age <37 weeks: tolerating ≥120 ml/kg/day feed volume.Interventions: PRBCT at 15 ml/kg, over 4 h.Main Outcome Measures: Transfusion-associated changes were determined by performing mixed models for repeated measures analysis between the 4-h mean pretransfusion values (SCOR 0, StO 2 s 0, and StO 2 c 0) and the post-transfusion hourly mean values for the next 28 h (SCOR 1-28, StO 2 s 1-28, and StO 2 c 1-28). Dunnett's method was used to adjust for the multiplicity of the p value.Results: Of 30 enrolled infants 14 [46.7%] male; median [IQR] birth weight, 923 [655-1064] g; gestation, 26.4 [25.5-28.1] weeks; enrolment weight, 1549 [1113-1882] g; and postmenstrual age, 33.6 [32.4-35.0] weeks, one infant was excluded because of corrupted NIRS data. With the commencement of PRBCT, SCOR demonstrated a downward trend throughout the study period. This drift was associated with an increasing StO 2 c trend, while StO 2 s remained unchanged throughout the study period.

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“…, lactate, base deficit, pH) with novel technologies, such as cerebral and somatic dynamic near infrared spectroscopy, may allow us to better quantify and monitor oxygen consumption and delivery and the decision to transfuse or to withhold transfusion. 81–86…”

Section: Moving Away From a Hemoglobin Number: Incorporating Physiolo...mentioning

confidence: 99%

“…Several studies, including two recent prospective trials, in extremely low-birth-weight preterm neonates demonstrated that cerebral and somatic oximetry may reflect tissue hypoxia better than the hemoglobin level alone. [81][82][83] In addition to increases in cerebral and somatic oxygenation and decreases in fractional oxygen extraction after blood transfusions, two recent studies found that oxygen extraction preferentially increases in the brain over the gut in more anemic and immature infants. 82,83 Another recent study compared the effect of erythrocyte transfusions on pulmonary vascular resistance by echocardiography and cerebral and splanchnic oxygen saturations in neonates with or without a patent ductus arteriosus.…”

Section: Moving Away From a Hemoglobin Number: Incorporating Physiolo...mentioning

confidence: 99%

“…[81][82][83] In addition to increases in cerebral and somatic oxygenation and decreases in fractional oxygen extraction after blood transfusions, two recent studies found that oxygen extraction preferentially increases in the brain over the gut in more anemic and immature infants. 82,83 Another recent study compared the effect of erythrocyte transfusions on pulmonary vascular resistance by echocardiography and cerebral and splanchnic oxygen saturations in neonates with or without a patent ductus arteriosus. 84 The authors report a decrease in pulmonary vascular resistance (change in right ventricular pressure) and cerebral oxygen extraction after erythrocyte transfusion in all patients, but neonates with patent ductus arteriosus had significantly lower splanchnic oxygen saturation and higher fractional oxygen extraction, even after an erythrocyte transfusion.…”

Section: Moving Away From a Hemoglobin Number: Incorporating Physiolo...mentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Pediatric Erythrocyte Transfusions: Incorporating Hemoglobin Thresholds and Physiologic Parameters in Decision-making

Downey

Goobie

2022

Anesthesiology

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Regional tissue oxygenation and conventional indicators of red blood cell transfusion in anaemic preterm infants

Cited by 8 publications

References 48 publications

Abdominal Near Infrared Spectroscopy can be reliably used to measure splanchnic oxygenation changes in preterm infants

Abdominal Near Infrared Spectroscopy can be reliably used to measure splanchnic oxygenation changes in preterm infants

Splanchnic‐cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants

Perioperative Pediatric Erythrocyte Transfusions: Incorporating Hemoglobin Thresholds and Physiologic Parameters in Decision-making

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