NYMC Faculty Publications

Monitoring Regional Tissue Oxygen Extraction in Neonates <1250 g Helps Identify Transfusion Thresholds Independent of Hematocrit

Author Type(s)

Faculty

DOI

10.3233/NPM-1477213

Journal Title

Journal of Neonatal-Perinatal Medicine

First Page

89

Last Page

100

Document Type

Article

Publication Date

1-1-2014

Department

Pediatrics

Second Department

Biochemistry and Molecular Biology

Keywords

Abdominal Cavity, Anemia, Neonatal, Biomarkers, Brain, Erythrocyte Transfusion, Female, Hematocrit, Humans, Infant, Newborn, Infant, Premature, Infant, Very Low Birth Weight, Kidney, Male, Monitoring, Physiologic, Oximetry, Oxygen, Patient Selection, Pilot Projects, Practice Guidelines as Topic, Spectroscopy, Near-Infrared, Splanchnic Circulation, Time Factors, Treatment Outcome

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVE: We sought to characterize the effects of "booster" packed red blood cell transfusions on multisite regional oxygen saturation in very low birth weight neonates during the first postnatal week and to examine the utility of fractional tissue oxygen extraction as an estimate of tissue oxygenation adequacy.

STUDY DESIGN: Data were collected in an observational near-infrared spectroscopy (NIRS) pilot survey of 500-1250 g neonates during the first postnatal week. A before-after analysis of "booster" transfusions, defined as empiric 15 mL/kg transfusion following 10 mL/kg cumulative phlebotomy losses, was conducted upon cardiopulmonary, laboratory, and spectroscopy data.

RESULT: Ten neonates (gestational age 26 ± 0 wk; birth weight 879 ± 49 g) received 14 transfusions at 3 ± 0 postnatal days. Mean hematocrit increased from 35.2 ± 1.2 to 38.5 ± 1.2 % (P < 0.05) following transfusion; pH, base deficit, lactate, creatinine, and cardiopulmonary parameters were unchanged. Cerebral, renal, and splanchnic tissue oxygenation increased 10, 18, and 16%, with concomitant decreases in calculated oxygen extraction of 27, 30, and 9% (all P < 0.05), consistent with enhanced tissue oxygenation. These findings were not observed in a non-transfused comparison group of nine patients.

CONCLUSION: "Booster" transfusions improved indices of regional tissue oxygenation while no departures were observed in conventional cardiovascular assessments. We speculate that NIRS-derived oxygenation parameters can provide an objective, graded, and continuous estimate of oxygen delivery-consumption balance not evident using standard monitoring techniques.

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