Red Blood Cell Transfusions Affect Intestinal and Cerebral Oxygenation Differently in Preterm Infants with and...

To assess intestinal and cerebral oxygenation during and after red blood cell (RBC) transfusions in preterms with or without subsequent transfusion-associated necrotizing enterocolitis (TANEC).

In preterms of < 32 weeks' gestational age, we measured intestinal and cerebral regional tissue oxygen saturation (r_intSO₂, r_cSO₂) and their variabilities using near-infrared spectroscopy during and after transfusions. We compared eight infants who developed TANEC 6 to 48 hours after RBC transfusions with 16 controls.

In TANEC infants, r_cSO₂ was lower during and after RBC transfusions than in controls, median (interquartile range) 55% (50-62) versus 72% (65-75), p < 0.01. There were no differences regarding r_intSO₂. Individual r_intSO₂ and r_cSO₂ ranges were smaller after transfusions in TANEC infants, 28% (9-36) versus 49% (40-65), p < 0.01, and 17% (14-33) versus 36% (26-57), p = 0.01, as was short-term r_intSO₂ variability. For each 10% higher r_cSO₂, the risk of developing TANEC decreased (odds ratio 0.09; 95% confidence interval 0.01-0.63). The smaller the r_intSO₂ range after transfusion, the higher the risk of developing TANEC.

In preterm infants lower r_cSO₂, but not r_intSO₂, values during and after RBC transfusions are associated with TANEC. Lower r_intSO₂ and r_cSO₂ variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC.