258 - Blood transfusion and changes in regional tissue oxygenation in preterm neonates

Regional tissue oxygenation depends on both oxygen delivery and oxygen consumption. Packed red blood cell (PRBC) transfusion can improve the oxygen-carrying capacity of blood thereby increasing oxygen delivery to organ tissue. Preterm infants commonly face conditions such as chronic lung disease, sepsis, and seizures which can increase oxygen consumption. Near-infrared spectroscopy (NIRS) is a non-invasive technology that measures tissue oxygen saturation of various organs. NIRS has been used to detect increase in cerebral (CrSo2) and splanchnic (SrSO2) oxygenation, as well as to calculate the splanchnic-cerebral oxygenation ratio (SCOR) immediately after blood transfusion.

Objective: To determine if improvement in tissue oxygenation is sustained after PRBC transfusion in preterm neonates.

Design/Methods:

Prospective observational study of preterm infants born between 25-31 weeks GA and with birth weights of 500-1500 grams. We excluded subjects with congenital heart disease, major congenital malformations, abdominal surgery, and grade III/ IV Intraventricular hemorrhage. NIRS data were recorded for transfusions occurring after the 3rd day of life. The CrSO2 and SrSO2 values were measured for 30 minutes immediately before and after transfusion, as well as at 24, 48, and 72 hours after transfusion. Analysis was done using ANOVA and Tukey HSD tests.

Results:

29 transfusions were recorded. The mean GA of subjects at birth was 27.7 ± 1.3 wks and at transfusion was 32.1±3.4 wks. The mean birth weight was 914.5 ± 233.8 g and at weight transfusion was 1331.4 ±501.5 g. Overall, there was a difference in CrSO2 values at the different measured time points (p< 0.01). Looking more specifically, there was a statistically significant increase in CrS02 from pretransfusion levels, 64.6 ± 6.8, both immediately after transfusion, 71.41 ± 7.1 (p< 0.01), and at 24 hours, 70.7 ± 6.1, (p< 0.05) after. Although CrSO2 values remained elevated at 48 hours, 69.4 ± 8.3, and at 72 hours, 67.8 ± 8.1, it was not statistically significant [Fig. 1]. The SrSO2 and SCOR were increased immediately after transfusion but were not found to be statistically significant. Changes in SrS02 and SCOR at 24, 48, and 72 hours after transfusion were not significant. [Tab.1, Fig. 2].

Conclusion(s):

There is a significant increase in cerebral tissue oxygenation after PRBC transfusion. However, this change may be only temporary in the days following transfusion. Any increase in splanchnic tissue oxygenation may be neither significant nor sustained. Clinicians should take this into account when considering neonatal transfusion needs.
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