4.6 Article

Cardiorespiratory monitoring of red blood cell transfusions in preterm infants

Journal

EUROPEAN JOURNAL OF PEDIATRICS
Volume 181, Issue 2, Pages 489-500

Publisher

SPRINGER
DOI: 10.1007/s00431-021-04218-5

Keywords

Red blood cell transfusion; Vital signs; Preterm infants; Hypoxia; Clinical decision-making

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Red blood cell transfusions can decrease the incidence of desaturations and hypoxia in preterm infants, especially if more desaturations have occurred before transfusion. Monitoring cardiorespiratory data may help identify infants who will benefit most from these transfusions.
Clinical improvement after red blood cell (RBC) transfusions in preterm infants remains debated. This study aims to investigate the effect of RBC transfusion on the occurrence of desaturations and hypoxia, and other cardiorespiratory outcomes in preterm infants. In this longitudinal observational study, prospectively stored cardiorespiratory parameters of preterm infants who received at least one RBC transfusion between July 2016 and June 2017 were retrospectively analyzed. Sixty infants with 112 RBC transfusions, median GA of 26.7 weeks, were included. The number of desaturations and area < 80% SpO(2) limit, as a measure of the hypoxic burden, were calculated in 24 h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, the mean (SE) number of desaturations per hour decreased from 3.28 (0.55) to 2.25 (0.38; p < 0.001), and area < 80% SpO(2) limit decreased from 0.14 (0.04) to 0.08 (0.02) %/s (p = 0.02). These outcomes were stratified for the number of desaturations in 24 h prior to RBC transfusion. The largest effect was observed in the group with the highest mean number of desaturations (>= 6) prior to RBC transfusion, with a decrease from 7.50 (0.66) to 4.26 (0.38) (p < 0.001) in the number of desaturations and 0.46 (0.13) to 0.20 (0.06) in the area < 80% SpO(2). Perfusion index increased significantly after RBC transfusion (p < 0.001). No other significant effects of RBC transfusion on cardiorespiratory data were observed. Conclusions: RBC transfusions in preterm newborns could help decrease the incidence of desaturations and the area < 80% SpO(2) as a measure of the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed. What is Known: center dot Red blood cell transfusions potentially prevent hypoxia in anemic preterm infants by increasing the circulatory hemoglobin concentration and improving tissue oxygenation. center dot There is not a predefined hemoglobin concentration cut-off for the occurrence of symptomatic anemia in preterm infants. What is New: center dot Oxygen desaturations and hypoxia in anemic preterm infants can be improved by RBC transfusions, especially if more desaturations have occurred before transfusion. center dot Cardiorespiratory monitor data may help identify infants who will benefit most from red blood cell transfusions.

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