Transfusion In Preterm Infants Research Articles

Iron Overload With Erythrocyte Transfusion in Preterm Infants

Iron Overload With Erythrocyte Transfusion in Preterm Infants

Cerebral and intestinal oxygen saturation of different volumes of red blood cell transfusion in preterm infants

ObjectivesThe purpose of this study was to investigate and compare the effects of 20 ml/kg and 15 ml/kg red blood cell transfusion (RBCT) on cerebral and intestinal tissue oxygenation, the number of administered transfusions, and neonatal complications in premature infants with anemia. MethodsThis prospective, randomized, partially blinded observational study investigated anemic neonates of gestational age < 32 weeks (Registration ID: ChiCTR 1,900,026,672). The infants were randomly assigned to receive 15 or 20 ml/kg red blood cell transfusion. Cerebral and intestinal tissue oxygen saturation (cer rSO2 and int rSO2) were collected 2 h before transfusion, 2, 4, 6, 12, 24, and 48 h after the beginning of transfusion by Near-infrared spectroscopy (NIRS). We also collected vital signs including heart rate (HR), peripheral oxygen saturation (SpO2), and mean arterial blood pressure (MABP) 2 h before infusion, 2 h, and 6 h after the beginning of transfusion. Then we analyzed and compared regional oxygen saturation(rSO2), fractional tissue oxygen extraction (FTOE), and other outcome readouts (blood transfusion numbers, changes in hematocrit and hemoglobin, hospitalization days, HR, SpO2, MABP, and complications) between the two groups. The intraindividual comparisons of the above readouts before transfusion and those after transfusion were also evaluated within each group. Result73 newborns received 20 ml/kg (large volume group) and 78 newborns received 15 ml/kg transfusion (small volume group). There was no significant difference in cer rSO2, int rSO2, Cerebral fractional tissue oxygen extraction (cFTOE), and intestinal fractional tissue oxygen extraction (iFTOE) between the two groups. rSO2, MABP, and SpO2 increased; HR, cFTOE, and iFTOE decreased following transfusion in both groups. The transfusion number of the large volume group is significantly less than that of the small volume group (1.9 ± 0.3 vs. 2.6 ± 0.9, p < 0.01) and hospitalization days were also less than those in the low volume group (44.3 ± 8.2 vs. 47.6 ± 9.8, p < 0.05). The increases in hematocrit and hemoglobin were higher in the large volume group than those in small volume (hematocrit increment (%),10.7 ± 4.2 vs. 10.1 ± 5.9, p = 0.015; Hb concentration after blood transfusion (g/L) 132.3 ± 11.1 vs. 127.4 ± 15.4, p = 0.028). ConclusionAfter the transfusion, cer rSO2 and int rSO2 increased significantly, FTOE decreased and vital signs improved in both the 15 ml/kg and 20 ml/kg groups, and these changes were not significantly different between the two groups. However, the larger group showed a more pronounced increase in hematocrit and hemoglobin, a reduction in the total number of transfusions, and a shorter duration of hospitalization after transfusion in preterm infants without increasing complications.

Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants

Preterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes. To determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age. This was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022. Near-infrared spectroscopy monitoring of Csat and Msat. Primary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score <85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment. A total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower-hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher-hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO2) in either group (0.2% vs -0.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03). In this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO2. Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia. ClinicalTrials.gov Identifier: NCT01702805.

Impact of Delayed Cord Clamping on Red Blood Cell Transfusion and Related Outcomes in Very Low Birth Weight Infants.

Delayed cord clamping (DCC) for 30 to 60 seconds after birth facilitates placental transfusion, increases blood volume, and decreases red blood cell (RBC) transfusion in preterm infants. Study objective was to determine (1) RBC transfusion burden over a 5-year period, (2) impact of DCC practice on RBC transfusions, and (3) association of RBC transfusion on outcomes in very low birthweight (VLBW) preterm infants. A retrospective medical chart review was performed in 787 VLBW infants between 2016 and 2020. Demographic factors, DCC status, number of RBC transfusions, and neonatal outcomes were determined in eligible infants. Adjusted association between DCC, RBC transfusion, and outcomes were determined using logistic and linear regression methods. Of the 538 eligible VLBW infants, 62% (N = 332) received RBC transfusions. Proportion receiving RBC transfusion were significantly higher for infants <1,000 g (N = 217, 65.4%) and gestational age (GA) <29 weeks (N = 256, 77.1%) than larger (1,001-1,250 g, N = 77, 23.2% and 1,251-1,500 g, N = 38, 11.4%) and older GA ≥ 29 weeks' infants (N = 76, 22.9%, p < 0.05). Of the 81/538 (15.1%) who received DCC, 48 (59.2%) received no RBC transfusion (p < 0.001). In multivariable logistic regression analysis, preterm infants with DCC were 55% less likely to receive RBC transfusions as compared with infants with no DCC. At any given GA, the number of RBC transfusions in preterm infants with DCC was 25% lower as compared with infants without DCC (p < 0.05). Transfusion was associated with 8-fold increased odds for bronchopulmonary dysplasia and 4-fold increased odds for medical and surgically treated patent ductus arteriosus compared with no transfusion. There was no significant association of transfusion with neonatal sepsis, laser treated retinopathy of prematurity, necrotizing enterocolitis, and intraventricular hemorrhage. DCC was significantly associated with reduced RBC transfusion, but fewer preterm infants received DCC. Further research is needed to explore the feasibility of providing neonatal resuscitation during DCC in preterm infants. · Delayed cord clamping significantly reduced the need for RBC transfusions.. · Fewer very preterm infants received DCC.. · Future research is needed to explore feasibility of neonatal resuscitation during DCC..

Splanchnic-cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants.

Splanchnic-cerebral oxygenation ratio (SCOR), the ratio of splanchnic tissue oxygen (StO2 s) to simultaneously measured cerebral tissue oxygen (StO2 c), has been described as a surrogate to detect impaired splanchnic oxygenation associated with hypoperfusion status such as necrotizing enterocolitis. This concept is based on the presumption that any change in SCOR indicates a corresponding change in splanchnic tissue oxygenation as the numerator, whereas cerebral tissue oxygenation as the denominator remains stable. However, it is questionable to utilise this concept to detect splanchnic oxygenation changes in the context of packed red blood cell transfusion (PRBCT). The current study examines the contribution of both cerebral and splanchnic oxygenation components to PRBCT-associated SCOR changes in preterm infants. Prospective cohort study. Neonatal intensive care. Hemodynamically stable infants: Gestation <32 weeks; birth weight <1500 g; postmenstrual age <37 weeks: tolerating ≥120 ml/kg/day feed volume. PRBCT at 15 ml/kg, over 4 h. Transfusion-associated changes were determined by performing mixed models for repeated measures analysis between the 4-h mean pre-transfusion values (SCOR 0, StO2 s 0, and StO2 c 0) and the post-transfusion hourly mean values for the next 28 h (SCOR 1-28, StO2 s 1-28, and StO2 c 1-28). Dunnett's method was used to adjust for the multiplicity of the p value. Of 30 enrolled infants 14 [46.7%] male; median [IQR] birth weight, 923 [655-1064] g; gestation, 26.4 [25.5-28.1] weeks; enrolment weight, 1549 [1113-1882] g; and postmenstrual age, 33.6 [32.4-35.0] weeks, one infant was excluded because of corrupted NIRS data. With the commencement of PRBCT, SCOR demonstrated a downward trend throughout the study period. This drift was associated with an increasing StO2 c trend, while StO2 s remained unchanged throughout the study period. PRBCT-associated SCOR decrease suggests improvement in cerebral oxygenation rather than worsening splanchnic oxygenation. Our study underlines that it is necessary to determine individual components of SCOR, namely cerebral and splanchnic StO2 to understand SCOR changes in the context of PRBCT.

Analysis of risk factors for blood transfusion in preterm infants based on statistical analyses

AbstractIn order to improve the analysis effect of risk factors for blood transfusion in preterm infants, this paper studies the natural gradient algorithm based on statistical analysis methods and analyzes the data processing effect of the algorithm. Moreover, this paper combines the analysis of risk factors for blood transfusion in preterm infants to build a factor analysis system based on statistical analysis algorithms and intelligent algorithms, and combines back propagation (BP) neural networks to build the statistical intelligence model. In addition, this paper designs experiments to verify the performance of the statistical intelligence model constructed in this paper, combines statistical methods to perform data processing, and analyzes experimental results through control experiments. From the experimental research results, it can be known that the statistical processing method of risk factors proposed in this paper has a certain effect. Simultaneously, through a large amount of data training research and analysis, it is confirmed that the system constructed in this paper has good data processing effects and can be applied to practice.

Effect of washed versus unwashed red blood cells on transfusion-related immune responses in preterm newborns.

ObjectivesTransfusion with washed packed red blood cells (PRBCs) may be associated with reduced transfusion‐related pro‐inflammatory cytokine production. This may be because of alterations in recipient immune responses.MethodsThis randomised trial evaluated the effect of transfusion with washed compared with unwashed PRBCs on pro‐inflammatory cytokines and endothelial activation in 154 preterm newborns born before 29 weeks’ gestation. Changes in plasma cytokines and measures of endothelial activation in recipient blood were analysed after each of the first three transfusions.ResultsBy the third transfusion, infants receiving unwashed blood had an increase in IL‐17A (P = 0.04) and TNF (P = 0.007), whereas infants receiving washed blood had reductions in IL‐17A (P = 0.013), TNF (P = 0.048), IL‐6 (P = 0.001), IL‐8 (P = 0.037), IL‐12 (P = 0.001) and IFN‐γ (P = 0.001). The magnitude of the post‐transfusion increase in cytokines did not change between the first and third transfusions in the unwashed group but decreased in the washed group for IL‐12 (P = 0.001), IL‐17A (P = 0.01) and TNF (P = 0.03), with the difference between the groups reaching significance by the third transfusion (P < 0.001 for each cytokine).ConclusionThe pro‐inflammatory immune response to transfusion in preterm infants can be modified when PRBCs are washed prior to transfusion. Further studies are required to determine whether the use of washed PRBCs for neonatal transfusion translates into reduced morbidity and mortality.

Feasibility of umbilical cord blood as a source of red blood cell transfusion in preterm infants.

Preterm infants born earlier than 32 weeks of gestational age (GA) often need red blood cell (RBC) transfusions, which have been associated with an increased incidence of complications of prematurity, due to changes in tissue oxygenation. Transfusion of umbilical cord blood (UCB) could be beneficial for this group. The aims of this study were: (i) to determine the RBC transfusion needs in infants <32 weeks in Hospital Clinic of Barcelona; (ii) to identify the target GA group that would benefit most from UCB transfusion; and (iii) to assess the current availability of UCB as a potential source of RBC transfusion for these premature infants in our tertiary referral blood bank. A retrospective observational study was performed on infants born at <32 weeks GA, divided into two groups: (i) extremely low gestational age neonates (ELGAN) (from 230 to 276 weeks) and (ii) very preterm neonates (VPN) (from 280 to 316 weeks). Their complications and transfusion rates were compared. Processing and availability of UCB samples in the reference blood bank were assessed. Overall, 1,651 infants <32 weeks GA were admitted in the study period. While 12.5% of VPN received at least one RBC transfusion, the percentage increased to 60% among the ELGAN. Retinopathy of prematurity and bronchopulmonary dysplasia were diagnosed more frequently in the ELGAN group (p<0.001) than in the VPN group. The annual average volume of RBC transfusion in our study group was 1.35 L (95% CI: 1.07-1.64). The reference blood bank was able to produce 16 L (95% CI: 14-18) of UCB-RBC per year. Considering the data obtained about RBC transfusion needs and morbidities, the ELGAN group has been identified as the target group that would benefit most from UCB-RBC transfusions. We have demonstrated that our blood bank is able to produce enough RBC from UCB. Randomised control trials are warranted to study the potential benefits of UCB compared to adult blood for RBC transfusions.

Sex-specific cytokine responses and neurocognitive outcome after blood transfusions in preterm infants.

BACKGROUND:The objective of this study was to determine sex-specific differences in inflammatory cytokine responses to RBC transfusion in preterm infants in the neonatal period and their relationship to later neurocognitive status.METHODS:Infants with a birth weight <1000 grams and gestational age 22–29 weeks were enrolled in the Transfusion of Prematures (TOP) trial. The total number of transfusions was used as a marker of transfusion status. 19 cytokines and biomarkers were analyzed from 71 infants longitudinally during neonatal period. 26 infants completed the Bayley Scales of Infant & Toddler Development, 3rd Edition (Bayley-III) at 12 months’ corrected age.RESULTS:Nine cytokine levels were significantly elevated in proportion to the number of transfusions received. Of those, one cytokine showed a sex-specific finding (p=0.004): monocyte chemoattractant protein, MCP-1, rose substantially in females (8.9% change per additional transfusion), but not males (−0.8% change). Higher concentrations of MCP-1 exclusively were associated with worse Bayley-III scores: decreased cognitive raw scores (p=0.0005) and motor scaled scores (p<0.0001).CONCLUSION:This study provides evidence of a sex-specific difference in the inflammatory response to RBC transfusions during neonatal life, with MCP-1 levels rising only in females and inversely correlating with neurocognitive status at 12 months old.

Hemodynamics of different volumes of red blood cell transfusion in preterm infants.

Although many controversies exist regarding the risk of red blood cell (RBC) transfusions, half of preterm infants born at <32weeks of gestational age receive such transfusions because of anemia of prematurity. Because of the costs and risks associated with multiple transfusions, it has been suggested that a large transfusion volume reduces the number of transfusions. However, there have been persistent concerns that RBC transfusion might lead to volume overload. We examined the impacts of large (20mL/kg) compared to standard volume (15mL/kg) transfusions on the hemodynamic variables of stable, electively transfused, preterm infants, by serially measuring echocardiographic parameters and plasma B-type natriuretic peptide levels. A total of 39 infants born at <34weeks of gestation and aged >2weeks at the time of enrollment were randomly allocated to either a standard volume (15mL/kg) or a large volume (20mL/kg) group. Significant reductions in cardiac output and transient increases in plasma B-type natriuretic peptide levels were found after RBC transfusion in both the standard and large volume (20mL/kg) groups. However, these changes were not significantly different between the two groups. Large-volume transfusions could be tolerable in stable preterm infants with anemia.

Effects of anemia and red blood cell transfusion in preterm infants on the development of bronchopulmonary dysplasia: a propensity score analysis

To determine association of severe anemia and red blood cell (RBC) transfusions with bronchopulmonary dysplasia (BPD) in preterm infants with gestational age <32 weeks, a retrospective analysis was conducted on 364 newborns from August 1,2018, until August 31,2020. 135 patients were diagnosed with BPD and the other 229 neonates were included in the non-BPD group. One-to-one propensity score matching (83:83) was used to match the baseline characteristics and confounding factors of patients so as to better evaluate effects of anemia and RBC transfusion. The results showed that the rate of severe anemia was significantly different between the BPD group and non-BPD group [14/83(16.87) vs 4/83(4.82), p = 0.013]. The number and volume of transfusion were significantly lower in the non-BPD group than in the BPD group [number:1(0,2) vs 2(0,4), p = 0.001;volume:30(0,40) vs 40(20,80), p = 0.004]. We find that Among anemic neonates,only severe anemia may increase the risk of developing BPD. Larger volume and higher number of RBC transfusions are related to BPD and its severity. Risk of BPD was neither related to the onset of anemia nor the timing of first transfusion. Medical methods should be adopted to prevent severe anemia and reduce RBC transfusions. Registration Name of registry: Chinese Clinical Trial Registry, Registry number: ChiCTR 2100042768. Registration date: 28 January, 2021. URL of the trial in the registry database:http://www.chictr.org.cn/listbycreater.aspx.

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

BackgroundNecrotising Enterocolitis (NEC) is a devastating neonatal disease. A temporal association between red cell transfusion and NEC has been recognized and there have been concerns about the effects of feeding during transfusion. We aimed to assess the effect of different enteral feeding regimens on splanchnic oxygenation in preterm infants receiving red cell transfusions.MethodsThis was an open, multi-arm, parallel-group, randomised controlled trial conducted in a single centre in Australia. We compared three different enteral feeding regimes during a single red cell transfusion in preterm infants < 35 weeks gestational age at birth. Infants were randomised to either: (1) Withholding enteral feeds for 12 h from the start of transfusion or; (2) Continuing enteral feeds or; (3) Restriction of enteral feed volume to 120 ml/kg/day (maximum 20 kcal/30 ml) for 12 h. The primary outcome was mean splanchnic-cerebral oxygenation ratio (SCOR) and mean splanchnic fractional oxygen extraction (FOE) before (1 h prior), during (1 h into transfusion) and after (end of transfusion; 12 and 24 h post) transfusion.ResultsThere were 60 transfusion episodes (20 transfusion episodes in each group) included in the analysis. 41 infants with a median gestational age at birth of 27 weeks (range 23–32 weeks) were enrolled. The median postnatal age was 43 days (range 19–94 days) and the median pre-transfusion haematocrit was 0.27 (range 0.22–0.32). All three groups were similar at baseline. There were no differences in mean SCOR and mean splanchnic FOE at any of the pre-specified time points. There were also no differences in clinical outcomes. There were no episodes of NEC in any infant. Across all groups the mean SCOR increased from the start to the end of each transfusion (0.97 [CI95% 0.96–0.98] vs 1.00 [CI95% 0.99–1.01]; p = 0.04) and the mean FOE decreased from the start to the end of each transfusion (0.22 [CI95% 0.21–0.23] vs 0.17 [CI95% 0.16–0.18]; p < 0.001).ConclusionsThere were no differences in splanchnic oxygenation when enteral feeds were either withheld, continued or restricted during a transfusion. However, the successful conduct of this study supports the feasibility of a large trial powered to assess clinical outcomes.Trial registrationANZCTR, ACTRN12616000160437. Registered 10 February 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370069

Umbilical Cord Milking in Infants Born at

Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects of UCM in newborns <37 weeks’ gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomized UCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest that UCM in premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67–0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55–1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55–3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03–2.29]), compared to the control groups. In infants born at <33 weeks, UCM was associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66–0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50–1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls.

Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants.

Understanding factors that impact tissue oxygen extraction may guide red blood cell (RBC) transfusion decision making in preterm infants. Our objective was to assess the influence of enteral feeding and anemia on cerebral and mesenteric oxygen saturation (Csat and Msat) and fractional tissue oxygen extraction (cFTOE and mFTOE) over the entire time course of RBC transfusion. Preterm, very low-birth-weight infants receiving RBC transfusions at a single center were enrolled. Near-infrared spectroscopy sensors measured Csat and Msat levels from an hour before transfusion to 24 hours after. During this period, changes in Csat, Msat, cFTOE, and mFTOE were described, and their association with enteral feeding status and pretransfusion degree of anemia were assessed using generalized estimating equations. RBC transfusion data from 31 preterm infants were included. Infants receiving enteral feeds exhibited lower pretransfusion Msat. Infants with pretransfusion hematocrit greater than 30% exhibited higher pretransfusion Csat and lower pretransfusion cFTOE. Such differences in baseline measurements persisted through 24 hours after transfusion. However, no statistically significant differences in oxygenation measures over time by enteral feeding or anemia status were identified. Compared to NPO, enteral feeding was associated with lower Msat; anemia (hematocrit ≤30%) was associated with lower Csat and higher cFTOE. Over the time course of RBC transfusion, trajectories of Csat, Msat, cFTOE and mFTOE did not differ by enteral feeding or anemia status.

Evaluation of Risk Factors Associated with Red Blood Cell Transfusion in Preterm Infants

Giriş-Amaç: Preterm bebeklere yenidoğan ünitesinde (YYBÜ) yatışları esnasında çoğu kez eritrosit süspansiyonu (ES) transfüzyonu (TF) yapılması gerekmektedir. Çok düşük doğum ağırlıklı (ÇDDA) bebeklerin %90 kadarına yaşamın ilk haftalarında bir veya daha fazla ES transfüzyonu yapılmaktadır.Çalışmamızda 34 gestasyonel haftanın (GH) altında doğan pretermlerde ES transfüzyonu ile ilişkili olabilecek risk faktörlerini değerlendirmeyi amaçladık. Materyal-Metod: Çalışmamıza YYBÜ’de takip edilen 34 GH altında doğan 68 bebeğin tıbbi kayıtları retrospektif olarak incelendi. Bebeklerin demografik verileri ve klinik verileri ile doğum sonrası alınan tüm kan örneklerinin sayısı kaydedildi.Bebekler TF yapılan ve yapılmayan grup olarak ikiye ayrılarak, istatistiksel olarak morbiditelerin oluşumu ve mortalite açısından kıyaslandı. Bulgular: Çalışmaya dahil edilen 68 olgunun 35‘ı kız (%51.4), 33’ü (%48.5) erkekti. Transfüzyon alan ve almayan olguların ortalama doğum tartıları ve gestasyon haftaları sırasıyla 1301 ± 402.8 g ile 1425 ± 462.3 g. (p&amp;gt;0.05) ve 30.0 ± 2.64 ile 30.8 ± 2.04 hafta idi (p&amp;gt;0.05). Olguların 25’ine (%36.7) çoklu TF tedavisi uygulanmıştı. TF olan grupta birinci, ikinci ve 3. TF günleri sırasıyla postnatal 21.4 ±10.9, 29.6±11.6 ve 32.83±8.9 gün idi. TF almayan ve alan grup kıyaslandığında doğum tartısı, gestasyon haftası, ventilatörde kalma süresi, hastanede yatış süresi, sepsis ve inotrop ihtiyacı açısından istatistiksel anlamlı fark bulundu (p&amp;lt;0.05). TF yapılan grupta kümülatif kan kaybı 7-14.gün arası anlamlı olarak yüksek saptandı (p&amp;lt;0.05). 14-28.gün arasında kümülatif kan kaybı açısından fark saptanmadı (p=0.009). Çoklu TF alan bebek grubunun ortalama tartı ve gestasyon haftasının sırasıyla 1041±205 gr ve 28.7±1.2 hafta olduğu görüldü. Çoklu TF alan gruptaki bebeklerin ventilatörde kalış süreleri de istatistiksel olarak yüksekti (p&amp;lt;0.05). PN 7.,14. ve 28. günlerde TF alan gruptaki bebeklerin tartı alımlarının daha az olduğu tespit edildi (p&amp;lt;0.05). TF alan grupta BPD görülme sıklığı anlamlı biçimde yüksekti. TF alan grupta ROP sıklığı daha yüksek saptansa da istatistiksel olarak anlamlı fark saptanmadı (p&amp;gt;0.05). Sonuç: Çalışmamızda TF alan bebeklerin doğum tartısı ve gestasyon haftasının daha düşük, ventilatörde kalma süresi,hastanede yatış süresi, sepsis görülme ve inotrop ihtiyacı sıklığının daha yüksek olduğunu saptadık.Özellikle ilk iki haftada alınan kan örnek sayısının fazla olması TF ihtiyacını arttırmakta idi. Pretermlerde ES TF ihtiyacının azaltılması için kan örneği alım sayısının azaltılması, mümkünse mikro yöntemlerin kullanılması ve invaziv olmayan monitörizasyon yöntemlerinin kullanılması gerekmektedir.

Stopping enteral feeds for prevention of transfusion-associated necrotising enterocolitis in preterm infants.

Feeding practices around the time of packed red blood cell transfusion have been implicated in the subsequent development of necrotising enterocolitis (NEC) in preterm infants. Specifically, it has been suggested that withholding feeds around the time of transfusion may reduce the risk of subsequent NEC. It is important to determine if withholding feeds around transfusion reduces the risk of subsequent NEC and associated mortality. • To assess the benefits and risks of stopping compared to continuing feed management before, during, and after blood transfusion in preterm infants • To assess the effects of stopping versus continuing feeds in the following subgroups of infants: infants of different gestations; infants with symptomatic and asymptomatic anaemia; infants who received different feeding schedules, types of feed, and methods of feed delivery; infants who were transfused with different blood products, at different blood volumes, via different routes of delivery; and those who received blood transfusion with and without co-interventions such as use of diuretics • To determine the effectiveness and safety of stopping feeds around the time of a blood transfusion in reducing the risk of subsequent necrotising enterocolitis (NEC) in preterm infants SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11), in the Cochrane Library; MEDLINE (1966 to 14 November 2018); Embase (1980 to 14 November 2018); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 14 November 2018). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs. Randomised and quasi-randomised controlled trials that compared stopping feeds versus continuing feeds around the time of blood transfusion in preterm infants. Two review authors independently selected trials, assessed trial quality, and extracted data from the included studies. The search revealed seven studies that assessed effects of stopping feeds during blood transfusion. However, only one RCT involving 22 preterm infants was eligible for inclusion in the review. This RCT had low risk of selection bias but high risk of performance bias, as care personnel were not blinded to the study allocation. The primary objective of this trial was to investigate changes in mesenteric blood flow, and no cases of NEC were reported in any of the infants included in the trial. We were unable to draw any conclusions from this single study. The overall GRADE rating for quality of evidence was very low. Randomised controlled trial evidence is insufficient to show whether stopping feeds has an effect on the incidence of subsequent NEC or death. Large, adequately powered RCTs are needed to address this issue.

The Frequency of Packed Red Blood Cells Transfusion in Preterm Infants Admitted to NICU of Shahid Sadoughi Hospital During 2016

Background: Red blood cells transfusion is a useful practice for preterm infants. Large amount of blood is usually wasted in the infants. Considering that few studies have been carried out on infants, the aim of current study was to investigate the frequency of packed red blood cells transfusion in preterm infants admitted to NICU of Shahid Sadoughi Hospital in Yazd during 2016 Materials and Methods: This retrospective descriptive-analytical study was conducted on infants admitted to Neonatal intensive care unit (NICU) of Shahid Sadoughi Hospital, Yazd, Iran during 2016. Variables including fetal age, sex, birth weight, delivery method, Apgar score, infant status, premature birth complications and transfusion information were extracted from medical records of patients. Results: Current study was conducted on 335 premature infants. Among them, 85 cases were received packed red blood cells transfusion (25.4%). Of the infants receiving packed red blood cells, 59 cases (69.4%) were alive and 26 (30.6%) dead. Distribution of preterm complications in infants including respiratory distress syndrome, sepsis, respiratory failure and Pneumothorax was observed in 66 (77.6%), 19(22.4%), 52(61.2%) and 14 patients (16.5%), respectively. There was significant difference between mean age and mean Apgar score in terms of transfusion (p&lt;0.01). The mean volume of consumed blood was 34.20 ± 27.44 ml. The mean volume of wasted blood was 488.39±355.88 ml. Minimum and Maximum volume of wasted blood was 220 and 1873 ml. Conclusion: According to results of current study, the mean age and mean Apgar score in patients undergoing transfusion was lower than those did not have transfusion. Moreover, total volume of wasted blood was 14.2 times more than consumed blood. Therefore, optimal usage of blood products and the use of smaller blood bags are proposed in order to improve the health of infants in intensive care units and lessen complications of blood transfusion in newborns.

Cut umbilical cord milking: an ineffective method of placental transfusion in preterm infants?

Objective: To determine if umbilical cord milking performed on a cut umbilical cord segment increased the hemoglobin/hematocrit, with a reduction in the incidence of intraventricular hemorrhage, need for blood transfusions, and pressor requirement in infants with <35-weeks gestation.Study design: This was a single center, observational study in the NICU. One-hundred-six neonates received cut umbilical cord milking and two hundred ninety seven served as historical controls.Result: There were no statistically significant differences between the two groups in hemoglobin/hematocrit, peak bilirubin values, the incidence of intraventricular hemorrhage, need for blood transfusions, and the use of pressors.Conclusion: This is the first study using the cut umbilical cord milking technique that includes neonates with <35-weeks gestation. The procedure is safe but did not result in an increase in hemoglobin/hematocrit, nor did it reduce the incidence of intraventricular hemorrhage, need for blood transfusions, and pressor use.

Cerebral oxygenation in preterm infants receiving transfusion.

The influence of severity of anemia and cardiac output (CO) on cerebral oxygenation (CrSO2) and on the change in CrSO2 following packed red blood cell (PRBC) transfusion in preterm infants has not been evaluated. The objectives of the current study were to evaluate the effect of pre-transfusion hemoglobin (Hb) and CO-weighted oxygen delivery index (ODI) on CrSO2 and on the post-transfusion CrSO2 change. Preterm infants of <32 weeks gestational age (GA) receiving PRBC transfusion were enrolled. Infants received 15 ml/kg PRBC over 3 h. CrSO2 by near-infrared spectroscopy and CO by electrical velocimetry were recorded for 1 h pre-ransfusion and post transfusion. ODI was defined as pre-transfusion Hb × CO. Thirty infants of 26.6 ± 2.0 weeks GA were studied at 19 ± 12 days. Pre-transfusion Hb was 9.8 ± 0.6 g/dl. Pre-transfusion CrSO2 correlated with pre-transfusion ODI (R2 = 0.1528, p = .044) but not with Hb level. The pre-transfusion to post-transfusion CrSO2 change correlated with pre-transfusion ODI (R2 = 0.1764, p = .029) but not with Hb level. CrSO2 increased from 66 ± 6% to 72 ± 7% post transfusion (p < .001), while arterial oxygen saturation, heart rate, and CO did not change. In these infants, the pre-transfusion ODI was a better indicator of brain oxygenation and its improvement post transfusion than Hb alone. The role of CO and tissue oxygenation monitoring in assessing the need for transfusion should be evaluated.

Do feeding practices during transfusion influence the risk of developing necrotising enterocolitis in preterm infants?

Our evidence-based review set out to answer the clinical question 'In a preterm infant (patient) with anaemia of prematurity, do feeding practices (intervention) during blood transfusion reduce the risk of developing transfusion-associated necrotising enterocolitis (outcome)'? We found limited evidence that withholding feeding during red blood cell transfusion in preterm infants may reduce the risk of development of transfusion-associated necrotising enterocolitis. As clinical equipoise seemingly exists, it seems reasonable for individual units to make their own decisions regarding whether to withhold or continue enteral feeds during red blood cell transfusion until further evidence is available. The UK-based Withholding Enteral Feeds Around Transfusion (WHEAT) trial, a nation-wide multi-centre 'opt-out' randomised controlled study, hopefully will definitively answer our clinical question. Further research in other areas of neonatal care, using this innovative study design, is needed and it is exciting to see such a study underway.