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Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia

Katrina T Ibonia1, Henrietta S Bada1, Philip M Westgate2

  • 1Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky.

Transfusion
|October 7, 2018
PubMed

Insights

Red blood cell (RBC) transfusions improve intermittent hypoxemia (IH) in preterm infants after the first week of life. However, the increase in perfusion index (PI) after transfusion did not correlate with this IH benefit.

Area of Science:

  • Neonatal Medicine
  • Pediatric Cardiology
  • Respiratory Physiology

Background:

  • Red blood cell (RBC) transfusions are known to decrease intermittent hypoxemia (IH) in infants after the first week of life.
  • Improved perfusion to the respiratory control network is a potential mechanism for this benefit.
  • Perfusion index (PI) is a non-invasive measure of perfusion obtained from pulse oximetry.

Purpose of the Study:

  • To test the hypothesis that increased PI after RBC transfusion is associated with improved IH.
  • To evaluate the predictive value of PI and clinical measures for the effect of RBC transfusion on IH.

Main Methods:

  • Prospective enrollment of infants <30 weeks' gestation.
  • Monitoring of PI and oxygen saturation (SpO2) using high-resolution pulse oximeters before and after RBC transfusion.
  • Analysis of data across three postnatal periods: 1-7 days, 8-28 days, and 4-8 weeks of life.

Main Results:

  • A total of 118 transfusions were analyzed.
  • IH measures significantly decreased in infants after the first week of life (Epochs 2 and 3).
  • PI significantly increased post-transfusion but did not correlate with IH reduction; mechanical ventilation, FiO2, and IH influenced oxygenation effects.

Conclusions:

  • RBC transfusion effectively improves IH in preterm infants beyond the first week of life.
  • The observed benefit in IH is not directly correlated with the post-transfusion increase in PI.
  • Pretransfusion respiratory support and IH severity are predictors of transfusion's impact on oxygenation.
Abstract

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