Presented at the Neonatal Society 2013 Autumn Meeting.
Banerjee J1, Asamoah F, Leung TS, Aladangady N
1 Department of Neonatology, Homerton University Hospital NHS Foundation Trust, London, UK
2 Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
3 Department of Medical Physics and Bioengineering, University College London, London, UK
Background: 90% of Extremely Low Birth Weight (ELBW) infants receive a blood transfusion (BT) (1). The benefits of BT are not clear (2,3).
Methods: Aim: To study the effect of blood transfusion on intestinal blood flow and oxygenation during the first week of life in extreme premature infants. Superior mesenteric artery (SMA) peak systolic and diastolic velocities were measured to assess intestinal blood flow using Doppler ultrasound scan (Logic P6, GE Healthcare) 30-60 minutes before and after BT. Intestinal oxygenation was measured using a near infrared spectroscopy (NIRS) device (NIRO 300, Hamamatsu Photonics Ltd, Japan), from 20-30 minutes before, during and 20-30 minutes post BT. Vital parameters (HR, respiratory rate, SaO2 and BP) were recorded continuously using ixtrend 2.0 software (ixellence, GmbH, Germany) during the NIRS measurement. Other data collected: gestational age, birth weight, pre and post-transfusion haemoglobin (Hb), blood gas (pH, pCO2and lactate) and feeding details. Data were analysed using STATA 12.0 statistical software. Continuous variables were compared using a paired t-test. The study was approved by Charing Cross REC, adopted as a NIHR Portfolio study (Study ID: 13594) and written parental consent was obtained.
Results: 20 infants were studied. Doppler measurements of all 20 infants were included in the analysis, 3 infants excluded from the NIRS analysis due to poor quality of data. The median gestational age was 26 weeks (range 23 – 27), birth weight 762.5 g (600 – 1180), age on day of BT 5 days (1 to 7) and male: female ratio 12:8. 50% of the infants were fed; 3 were receiving feeds >50 ml/kg/day. There was no significant change in heart rate, respiratory rate and saturation, but BP increased significantly following BT. The Hb significantly increased (p<0.0001; 95% CI 2.12 to 3.04) and lactate decreased (p=0.02; 95% CI 0.11 to 1.30), and there was no difference in pCO2(p=0.47) or pH (p=0.51) following BT. There was no significant difference between the pre-BT (0.65 m/s) and post-BT (0.59 m/s) mean SMA peak systolic velocity (p=0.35). The mean pre-BT SMA peak velocity was higher in fed (n=10, 0.78 m/s) compared to unfed (n=10, 0.52 m/s) infants (p=0.06). The changes in SMA peak systolic velocity following BT was not significantly different between the fed and unfed infants (p=0.72). There was a significant increase in intestinal HbO2concentration (mean difference 14.85 µM; p=0.04) following BT. The mean pre-BT intestinal tissue oxygenation index (TOI) (35.48%) also increased significantly post-BT (50.07%; p=0.03).
Conclusion: BT had no impact on intestinal blood flow but improved intestinal tissue oxygenation in extreme premature infants during the first week of life.
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1. Maier, RF et al. J Pediatr 2000. 136(2): p. 220-4
2. Bell, EF et al. Pediatrics 2005. 115(6): p. 1685-91