The effect of haemoglobin and blood transfusion on preterm infant gut perfusion and injury
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Introduction: There is significant uncertainty regarding the role that anaemia or
red blood cell transfusion (RBCT) plays in the development of gut injury in
preterm infants. This study evaluated Near Infrared Spectroscopy (NIRS)
together with a range of known biomarkers of gut inflammation to identify
their relationship with anaemia and RBCT.
Method: A prospective observational study of preterm infants born at <30 weeks
gestation was conducted from birth until either 36 weeks post conceptional age
or discharge home. Gut perfusion and biomarkers of gut injury were assessed
weekly by: 60 min NIRS measurements (splanchnic tissue oxygenation index
[sTOI] and fractional tissue oxygenation extraction [sFTOE]); stool calprotectin;
urine intestinal and liver fatty acid binding proteins (I-FABPs and L-FABPs); and
trefoil factor 3 (TFF-3). Exclusion criteria included Fetal Growth Restriction
(FGR), and abnormal antenatal Dopplers. Haemoglobin (Hb) levels were
measured in parallel with NIRS measurements. NIRS, together with urine and
stool biomarkers of gut injury, were evaluated up to 72 h pre/post RBCT and
pre/post measurements compared.
Results: Forty-eight infants were studied. Median (range) gestational age was
26 + 3 (23 + 0 to 29 + 6) weeks and birthweight 883.5 g (460–1,600). Seven
(14.6%) infants developed ≥ Bells stage 2 NEC. 28 (58.3%), 5 (10.4%) and 24
(50%) infants had ECHO confirmed PDA, haemorrhagic parenchymal infarct
(HPI) and IVH respectively. There were 22 episodes of sepsis. Infants were in
the study for a median of 7.3 (1–13) weeks. There was no significant
association between Hb divided into three categories (<80 g/L, 80–111.9 g/L
and ≥120 g/L) or continuous values and sTOI, sFTOE or any of the gut injury
biomarkers measured (p > 0.05). 283 RBCTs were administered; 117 (41.3%)
within the first two weeks of life. Pre and post blood transfusion changes in
splanchnic NIRS oxygenation, urine and stool gut injury biomarkers were
measured in 165, 195 and 175 episodes of RBCT respectively. There was no
significant post RBCT changes in splanchnic NIRS or gut injury biomarker levels
(p > 0.05). However, post RBCT calprotectin was significantly reduced during the
first 14 days of life (mean difference −114%, CI −185 to −42 & p 0.002).
red blood cell transfusion (RBCT) plays in the development of gut injury in
preterm infants. This study evaluated Near Infrared Spectroscopy (NIRS)
together with a range of known biomarkers of gut inflammation to identify
their relationship with anaemia and RBCT.
Method: A prospective observational study of preterm infants born at <30 weeks
gestation was conducted from birth until either 36 weeks post conceptional age
or discharge home. Gut perfusion and biomarkers of gut injury were assessed
weekly by: 60 min NIRS measurements (splanchnic tissue oxygenation index
[sTOI] and fractional tissue oxygenation extraction [sFTOE]); stool calprotectin;
urine intestinal and liver fatty acid binding proteins (I-FABPs and L-FABPs); and
trefoil factor 3 (TFF-3). Exclusion criteria included Fetal Growth Restriction
(FGR), and abnormal antenatal Dopplers. Haemoglobin (Hb) levels were
measured in parallel with NIRS measurements. NIRS, together with urine and
stool biomarkers of gut injury, were evaluated up to 72 h pre/post RBCT and
pre/post measurements compared.
Results: Forty-eight infants were studied. Median (range) gestational age was
26 + 3 (23 + 0 to 29 + 6) weeks and birthweight 883.5 g (460–1,600). Seven
(14.6%) infants developed ≥ Bells stage 2 NEC. 28 (58.3%), 5 (10.4%) and 24
(50%) infants had ECHO confirmed PDA, haemorrhagic parenchymal infarct
(HPI) and IVH respectively. There were 22 episodes of sepsis. Infants were in
the study for a median of 7.3 (1–13) weeks. There was no significant
association between Hb divided into three categories (<80 g/L, 80–111.9 g/L
and ≥120 g/L) or continuous values and sTOI, sFTOE or any of the gut injury
biomarkers measured (p > 0.05). 283 RBCTs were administered; 117 (41.3%)
within the first two weeks of life. Pre and post blood transfusion changes in
splanchnic NIRS oxygenation, urine and stool gut injury biomarkers were
measured in 165, 195 and 175 episodes of RBCT respectively. There was no
significant post RBCT changes in splanchnic NIRS or gut injury biomarker levels
(p > 0.05). However, post RBCT calprotectin was significantly reduced during the
first 14 days of life (mean difference −114%, CI −185 to −42 & p 0.002).
Date Issued
2024-11-22
Date Acceptance
2024-10-28
Citation
Frontiers in Pediatrics, 2024, 12
ISSN
2296-2360
Publisher
Frontiers Media S.A.
Journal / Book Title
Frontiers in Pediatrics
Volume
12
Copyright Statement
© 2024 Howarth, Mifsud, Banerjee, Eaton, Leung, Fleming, Morris and Aladangady. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39649403
Subjects
NEC
blood transfusion
gut injury
gut perfusion
haemoglobin
preterm infants
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
1440537
Date Publish Online
2024-11-22