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

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 (r (int) SO (2) , r (c) SO (2) ) 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, r (c) SO (2) 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 r (int) SO (2) . Individual r (int) SO (2) and r (c) SO (2) 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 r (int) SO (2) variability. For each 10% higher r (c) SO (2) , the risk of developing TANEC decreased (odds ratio 0.09; 95% confidence interval 0.01-0.63). The smaller the r (int) SO (2) range after transfusion, the higher the risk of developing TANEC. Conclusion In preterm infants lower r (c) SO (2) , but not r (int) SO (2) , values during and after RBC transfusions are associated with TANEC. Lower r (int) SO (2) and r (c) SO (2) variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC.