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Am J Perinatol 2018; 35(11): 1031-1037
DOI: 10.1055/s-0038-1636532
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Willemien S. Kalteren
1   Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, The Netherlands
,
Sara J. Kuik
1   Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, The Netherlands
,
Koenraad N. J. A. Van Braeckel
1   Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, The Netherlands
,
Jan B. F. Hulscher
2   Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
,
Arend F. Bos
1   Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, The Netherlands
,
Elisabeth M. W. Kooi
1   Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, The Netherlands
,
Michelle E. van der Laan
1   Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, The Netherlands
› Author Affiliations
Funding This study was part of the research program of the Graduate School of Medical Sciences, Research Institute SHARE, University of Groningen. Authors W.S. Kalteren and S.J. Kuik were financially supported by the Junior Scientific Master Class of the University of Groningen.
Further Information

Publication History

04 September 2017

24 January 2018

Publication Date:
06 March 2018 (online)

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Abstract

Objective To assess intestinal and cerebral oxygenation during and after red blood cell (RBC) transfusions in preterms with or without subsequent transfusion-associated necrotizing enterocolitis (TANEC).

Study Design In preterms of < 32 weeks' gestational age, we measured intestinal and cerebral regional tissue oxygen saturation (rintSO2, rcSO2) and their variabilities using near-infrared spectroscopy during and after transfusions. We compared eight infants who developed TANEC 6 to 48 hours after RBC transfusions with 16 controls.

Results In TANEC infants, rcSO2 was lower during and after RBC transfusions than in controls, median (interquartile range) 55% (50–62) versus 72% (65–75), p < 0.01. There were no differences regarding rintSO2. Individual rintSO2 and rcSO2 ranges were smaller after transfusions in TANEC infants, 28% (9–36) versus 49% (40–65), p < 0.01, and 17% (14–33) versus 36% (26–57), p = 0.01, as was short-term rintSO2 variability. For each 10% higher rcSO2, the risk of developing TANEC decreased (odds ratio 0.09; 95% confidence interval 0.01–0.63). The smaller the rintSO2 range after transfusion, the higher the risk of developing TANEC.

Conclusion In preterm infants lower rcSO2, but not rintSO2, values during and after RBC transfusions are associated with TANEC. Lower rintSO2 and rcSO2 variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC.

Keywords

red blood cell transfusion - intestinal regional tissue oxygen saturation - cerebral regional tissue oxygen saturation - necrotizing enterocolitis - preterm infants - variability - hemoglobin - near-infrared spectroscopy

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