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Saturación regional de oxígeno mesentérica durante la transfusión sanguínea en neonatos prematuros / Regional mesenteric oxygen saturation during blood transfusion in premature neonates
Resumen
Resumen
Introducción: la anemia neonatal en recién nacidos prematuros (RNPT) es frecuente y la transfusión es uno de los tratamientos de elección; sin embargo, se ha asociado al desarrollo de enterocolitis necrotizante (ECN).
Objetivo: comparar la saturación regional de oxígeno (rSO2) y la fracción excretada de oxígeno tisular (FTOE) basal, durante y al final de la transfusión en RNPT con anemia.
Material y métodos: estudio prospectivo, observacional, longitudinal y analítico. Se incluyeron RNPT de 28-36 semanas de edad gestacional (SEG) que ingresaron a una unidad de cuidados intensivos neonatales (UCIN) con base en los criterios de transfusión de los Canadian Blood Services. Se midió la rSO2, una hora antes, durante y hasta una hora después de la transfusión.
Resultados: se analizaron 20 RNPT, 3 (15%) niñas y 17 (85%) niños, de 33 SEG (RIC 28-36), edad postnatal de 31 días (RIC 15-50) y peso de 1815 g (RIC 1385-2520). Se analizaron los valores de rSO2 antes, durante y después de la transfusion de eritrocitos 45.5% (RIC 38.25-60.25), 53.3% (RIC 44.25-64) y 53.5% (RIC 50.0-64.25), respectivamente, F = 5.76, p = 0.006, power = 0.83, gl = 2; los valores de FTOE mostraron 0.50 (RIC 0.31-0.56), 0.42 (RIC 0.30-0.50) y 0.39 (RIC 0.27-0.45), respectivamente, F = 3.53, p = 0.03, power = 0.62, gl = 2.
Conclusión: las mediciones mesentéricas de rSO2 incrementaron y las de FTOE disminuyeron paulatinamente, previo, durante y después de la transfusión de eritrocitos, sin mostrar correlación con la hemoglobina previa a la transfusión.
Abstract
Background: Neonatal anemia (NA) in premature newborns (PTNB) is common and transfusion is one of the treatments of choice; however, it has been associated with the development of necrotizing enterocolitis (NEC).
Objective: To compare regional oxygen saturation (rSO2) and fraction of tissue oxygen excretion (FTOE) at baseline, during and at the end of transfusion in PTNBs with anemia.
Material and methods: Prospective, observational, longitudinal, and analytical study. PTNBs of 28-36 weeks of gestational age (WGA) admitted to a Neonatal Intensive Care Unit (NICU) and with transfusion criteria of Canadian Blood Services were included. rSO2 was measured one hour before, during and up to one hour after transfusion.
Results: 20 PTNBs were analyzed, 3 (15%) girls and 17 (85%) boys, aged 33 WGA (IQR 28-36), postnatal age 31 days (IQR 15-50), and weight of 1815 g (IQR 1385-2520). The rSO2 values before, during and after erythrocyte transfusion were 45.5% (IQR 38.25-60.25), 53.3% (IQR 44.25-64.0) and 53.5% (IQR 50.0-64.25), respectively, F = 5.76, p = 0.006, power = 0.83, DF = 2; FTOE values were 0.50 (IQR 0.31-0.56), 0.42 (IQR 0.30-0.50), and 0.39 (IQR 0.27-0.45), respectively, F = 3.53, p = 0.03, power = 0.62, DF = 2.
Conclusion: Mesenteric rSO2 measurements increased and FTOE decreased gradually before, during and after erythrocyte transfusion, without showing correlation with pretransfusion hemoglobin.
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Colombatti R, Sainati L, Trevisanuto D. Anemia and transfusion in the neonate. Semin Fetal Neonatal Med. 2016;21(1):2-9. doi: 10.1016/j.siny.2015.12.001
German KR, Juul SE. Neonatal Anemia. Curr Pediatr Rev. 2023;19(4):388-94. doi: 10.2174/1573396319666221121140627
Boix H, Sánchez-Redondo MD, Cernada M, et al; en representación del Comité de Estándares. Sociedad Española de Neonatología. Recommendations for transfusion of blood products in neonatology. An Pediatr (Engl Ed). 2022;97(1):60.e1-60.e8. doi: 10.1016/j.anpede.2022.05.003
López-Catzín JF, Bolado-García PB, Gamboa-López GJ, et al. Disminución de transfusiones en prematuros con anemia tratados con eritropoyetina. Rev Med Inst Mex Seg Soc. 2016;54(5):576-80.
Bell EF. Red cell transfusion thresholds for preterm infants: finally some answers. Arch Dis Child Fetal Neonatal Ed. 2022;107(2):126-30. doi: 10.1136/archdischild-2020-320495
Lau W. Neonatal and Pediatric Transfusion: Clinical guide to transfusion. Ontario: Canadian Blood Services; 2017. Disponible en: https://professionaleducation.blood.ca/en/transfusion/clinical-guide/neonatal-and-pediatric-transfusion.
Dang D, Gu X, Jiang S, et al. RBC transfusion and necrotizing enterocolitis in very preterm infants: a multicenter observational study. Sci Rep. 2024;14(1):14345. doi: 10.1038/s41598-024-64923-7
Mishra V, Mathur AA, Mohamed S, et al. Role of Near-infrared Spectroscopy in the Diagnosis and Assessment of Necrotizing Enterocolitis. Newborn (Clarksville). 2022;1(1):177-81. doi: 10.5005/jp-journals-11002-0001
Vesoulis ZA, Mintzer JP, Chock VY. Neonatal NIRS monitoring: recommendations for data capture and review of analytics. J Perinatol. 2021;41(4):675-88. doi: 10.1038/s41372-021-00946-6
McNeill S, Gatenby JC, McElroy S, et al. Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infants. J Perinatol. 2011;31(1):51-7. doi: 10.1038/jp.2010.71
Arman D, Sancak S, Gürsoy T, et al. The association between NIRS and Doppler ultrasonography in preterm infants with patent ductus arteriosus. J Matern Fetal Neonatal Med. 2020;33(7):1245-52. doi: 10.1080/14767058.2019.163966
Banerjee J, Leung TS, Aladangady N. Blood transfusion in preterm infants improves intestinal tissue oxygenation without alteration in blood flow. Vox Sang. 2016;111(4):399-408. doi: 10.1111/vox.12436
Li L, Wu R, Kog X, et al. Effect of anemia and blood transfusion on tissue oxygen Int J Clin Exp Med. 2017;10(2):2974-9.
Cáceres F, Castañón M, Lerena J, et al. Flujo mesentérico en un modelo experimental de enterocolitis necrotizante por isquemia - reperfusión en ratas. Anales de Pediatría. 2014:80(3);151-8. doi: 10.1016/j.anpedi.2013.05.022
Gumulak R, Lucanova LC, Zibolen M. Use of near-infrared spectroscopy (NIRS) in cerebral tissue oxygenation monitoring in neonates. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017;161(2):128-33. doi: 10.5507/bp.2017.012
Balegar V KK, Low GK, Nanan RK. Regional tissue oxygenation and conventional indicators of red blood cell transfusion in anaemic preterm infants. EClinicalMedicine. 2022;4;46:101365. doi: 10.1016/j.eclinm.2022
Dani C, Pratesi S, Fontanelli G, et al. Blood transfusions increase cerebral, splanchnic, and renal oxygenation in anemic preterm infants. Transfusion. 2010;50(6):1220-6. doi: 10.1111/j.1537-2995.2009.02575.x
Van Hoften JC, Verhagen EA, Keating P et al. Cerebral tissue oxygen saturation and extraction in preterm infants before and after blood transfusion. Arch Dis Child Fetal Neonatal Ed. 2010;95(5):F352-8. doi: 10.1136/adc.2009.163592
Neunhoeffer F, Hofbeck M, Schuhmann MU, et al., Cerebral Oxygen Metabolism Before and After RBC Transfusion in Infants Following Major Surgical Procedures. Pediatr Crit Care Med. 2018;19(4):318-27. doi: 10.1097/PCC.0000000000001483
Bailey SM, Hendricks-Muñoz KD, Wells JT, et al. Packed red blood cell transfusion increases regional cerebral and splanchnic tissue oxygen saturation in anemic symptomatic preterm infants. Am J Perinatol. 2010;27(6):445-53.
Bruckner M, Wolfsberger CH, Dempsey EM, et al. Normal regional tissue oxygen saturation in neonates: a systematic qualitative review. Pediatr Res. 2021;20. doi: 10.1038/s41390-021-01786-y
Chock V, Smith E, Tan S, et al. Early Brain and Abdominal Oxygenation in Extremely Low Birth Weight Infants. Pediatr Res. 2022;92(4):1034-41. doi: 10.1038/s41390-022-02082-z
Goldstein GP, Rao A, Ling AY,et al. Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants. Transfusion. 2020;60(3):466-72. doi: 10.1111/trf.15680
Killion E. Feeding Practices and Effects on Transfusion-Associated Necrotizing Enterocolitis in Premature Neonates. Adv Neonatal Care. 2021;21(5):356-64. doi: 10.1097/ANC.0000000000000872
He J, Sun X, Xu X, et al. Effects of the feeding protocol during blood transfusion on splanchnic tissue oxygenation and complications in very premature infants. Front Nutr. 2024;11:1408717. doi: 10.3389/fnut.2024.1408717
Salas AA, Gunn E, Carlo WA,et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network. Timing of Red Blood Cell Transfusions and Occurrence of Necrotizing Enterocolitis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024;7(5):e249643. doi: 10.1001/jamanetworkopen.2024.9643
MohanKumar K, Namachivayam K, Song T, et al. A murine neonatal model of necrotizing enterocolitis caused by anemia and red blood cell transfusions. Nat Commun. 2019 Aug 2;10(1):3494. doi: 10.1038/s41467-019-11199-5
Kalteren WS, Bos AF, van Oeveren W, et al. Neonatal anemia relates to intestinal injury in preterm infants. Pediatr Res. 2022 May;91(6):1452-8. doi: 10.1038/s41390-021-01903-x
Chock VY, Kirpalani H, Bell EF. Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants: A Secondary Near-Infrared Spectroscopy Study of the Transfusion of Prematures Randomized Clinical Trial (TOP NIRS). JAMA Netw Open. 2023;6(9):e2334889. doi: 10.1001/jamanetworkopen.2023.34889
Kirpalani H, Bell EF, Hintz SR, et al. Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. N Engl J Med. 2020;383(27):2639-2651. doi: 10.1056/NEJMoa2020248
DOI: https://doi.org/10.24875/10.5281/zenodo.15178476
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