Oxygen content and prediction of packed red blood cell transfusion in mechanically ventilated neonate

Abstract

Background: Packed blood cell transfusion in mechanically ventilated neonate is a prime necessity to maintain adequate tissue oxygen supply. Hemoglobin (Hb) is the gold standard for making decision of blood transfusion. Hb estimation is time-consuming in relation to arterial blood gas analysis, total oxygen content (CaO2) is one of the components of the blood gas. In this study, we wanted to predict CaO2as a predictor for blood transfusion in mechanically ventilated baby. Materials and Methods: This is a cross-sectional study conducted to assess the performance of CaO2to detect the indication of packed red blood cell transfusion in mechanically ventilated neonates. CaO2and corresponding venous hemoglobin were measured in normally perfused baby. Test performance of CaO2with different cut-off value was validated by receiver operating curve, sensitivity, specificity and positive predictive value (PPV), and negative predictive value (NPV). Results: Prevalence rate of packed red blood transfusion in mechanically ventilated neonate was 53%. With setting a cut-off value for Hb of 13 g/dl for blood transfusion, the best cut-off value of CaO2for blood transfusion is 18.5 ml/dl and area under curve 0.802, sensitivity is 80% and specificity is 78%, PPV 76%, and NPV 82% and cut value of CaO2off ≤20 ml/dl area under curve 0.97 (95% confidence interval 0.95–1) and specificity 93% and PPV 96% and NPV 95%. Conclusion: Our study concluded that CaO2is an excellent predictor of blood transfusion in a positive-pressure ventilated baby, but actual decision should be taken according to clinical condition of the patient.