Effect of red blood cell transfusion on cerebral tissue oxygenation in premature infants

Objective To analyze the changes in cerebral oxygen saturation (CrSO2) and cerebral fractional oxygen extraction ratio (CFOE) before, during and after red blood cell (RBC) transfusion in premature infants, and to explore the effect of RBC transfusion on the cerebral tissue oxygenation in premature infants. Methods The preterm infants with gestational age<37 weeks who were treated with RBC transfusion were selected from September 2017 to March 2018 in Neonatal Department of Children′s Hospital of Fudan University.Near-infrared spectroscopy (NIRS) was applied to continuously monitor CrSO2 from 2 h before RBC transfusion to 24 h after RBC transfusion.Transcuta-neous arterial oxygen saturation (TcSaO2), heart rate (HR) and blood pressure (BP) were synchronously measured by using multi-function monitor.CFOE could be calculated based on the monitored TcSaO2. Results A total of 71 cases were included in the study, 39 males and 32 females, with a medium gestational age of 29 (24-37) weeks, a mean birth weight of 2 195 (710-3 950) g, 17 cases in moderate anemia group and 54 cases in severe anemia group.Compared with the data 2 h before transfusion, CrSO2 increased (t=9.536, P<0.001), while CFOE decreased (t=-8.688, P<0.001) during transfusion in the whole study population.The CrSO2 at 2 h before blood transfusion, during blood transfusion, 2, 6, 12 and 24 h after transfusion were 0.579±0.037, 0.591±0.032, 0.599±0.035, 0.596±0.035, 0.595±0.027, 0.585±0.022, respectively in moderate anemia group and were 0.571±0.038, 0.592±0.039, 0.605±0.038, 0.603±0.035, 0.596±0.032, 0.596±0.032, respectively in severe anemia group.The CFOE at 2 h before blood transfusion, during blood transfusion, 2, 6, 12 and 24 h after transfusion were 0.40±0.04, 0.38±0.03, 0.37±0.04, 0.38±0.04, 0.38±0.03, 0.38±0.03, respectively in moderate anemia group and were 0.42±0.04, 0.39±0.04, 0.38±0.04, 0.38±0.04, 0.39±0.03, 0.39±0.03, respectively in severe anemia group.CrSO2 increased (t=3.874, P<0.05), while CFOE decreased (t=-4.091, P<0.05) at 2 h after transfusion in moderate anemia group.In severe anemia group, CrSO2 significantly increased (t=9.221, P<0.001), while CFOE significantly decreased (t=-8.583, P<0.001) during transfusion, and this effect lasted until 2 h after transfusion (t=5.926, -5.556, P<0.001). Compared with the data 2 h before transfusion, CrSO2 was significantly increased (t=6.894, P<0.001), while CFOE was significantly decreased (t=-8.536, P<0.001) at 24 h after transfusion in severe anemia group.However, there was no signi-ficant difference in CrSO2 and CFOE between the 24 h after transfusion and 2 h before in the moderate anemia group. Conclusions RBC transfusion improves cerebral tissue oxygenation, and severe anemia group benefit more from blood transfusion.Cerebral oxygenation monitoring with NIRS monitor may provide new insights for the clinical management of RBC transfusion in preterm infants. Key words: Infant, premature; Blood transfusion; Spectroscopy, near-infrared; Brain; Oxygen