Abstract
Literature supports an association between transfusions and gut injury in preterm infants. We hypothesized that packed red blood (PRBC) transfusions are associated with kidney inflammation marked by a rise in urinary levels of Kidney Injury Molecule 1 (KIM-1). Prospectively, KIM-1 levels were measured before and then at 6, 12 and 24 h after a PRBC transfusion. Results are presented as mean (± SD) and median (IQR). Thirty-four infants, birth weight 865 (± 375) g, had higher pretransfusion KIM-1 levels of 2270 (830, 3250) pg/mg than what is normal for age. These were not associated with hematocrit levels. KIM-1 levels peaked between 6 and 12 h after the transfusion. Levels peaked to 3300 (1990, 6830) pg/mg; levels returned to pretransfusion levels of 2240 (1240, 3870) pg/mg by 24 h, p < 0.01. The 24-h post-transfusion KIM-1 levels were similar to pretransfusion levels, p = 0.63. PRBC transfusions in preterm infants are associated with an elevation in urinary KIM-1 levels. The mechanism of this association may be important in studying transfusion associated organ injury. KIM-1, as an inflammatory marker, may be helpful in assessing the effect of different transfusion volumes or in evaluating operational thresholds of anemia in premature infants.
Highlights
Literature supports an association between transfusions and gut injury in preterm infants
There was no association between pretransfusion degree of anemia based on hematocrit levels and pretransfusion Kidney Injury Molecule 1 (KIM-1) levels
This study demonstrated a temporal association between the intervention of receiving a blood transfusion and the outcome of an increase in the level of the kidney inflammatory marker KIM-1
Summary
Literature supports an association between transfusions and gut injury in preterm infants. PRBC transfusions in preterm infants are associated with an elevation in urinary KIM-1 levels The mechanism of this association may be important in studying transfusion associated organ injury. With evidence supporting an association between transfusions and inflammation in different body organs, it is very likely that the preterm infant neonatal kidney is affected by PRBC transfusions. Studying this process has recently become easier with the availability of normal values for different kidney inflammatory markers across gestational ages. It was hypothesized that in preterm infants, blood transfusions are associated with kidney inflammation as evidenced by an increase in urinary levels of KIM-1. Our secondary objective was to elucidate a timeline of when the inflammation peaks and resolves
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