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Impact of red blood cell transfusions on intestinal barrier function in preterm infants
O O Ajayi1, N L Davis1, B Saleem1
1Department of Pediatrics, University of Maryland School of Medicine, Division of Neonatology Baltimore, MD, USA.
Insights
Red blood cell transfusions in preterm infants (<33 weeks gestation) are linked to increased intestinal permeability. Exclusive breast milk feeding and higher post-menstrual age may mitigate this risk.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Pediatric Research
Background:
- Intestinal permeability (IP) is crucial for nutrient absorption and immune function in neonates.
- Preterm infants (<33 weeks gestation) are particularly vulnerable to disruptions in intestinal barrier integrity.
- Factors like red blood cell (RBC) transfusion and enteral feeding can influence IP in this population.
Purpose of the Study:
- To investigate the relationship between RBC transfusions and enteral feeding with changes in intestinal permeability in preterm infants.
- To quantify intestinal permeability using the lactulose (La) and rhamnose (Rh) uptake method.
Main Methods:
- A cohort of preterm infants (<33 weeks gestation) received enterally administered La/Rh solution on study days 1, 8, and 15.
- Urinary La/Rh ratios were measured by High-Performance Liquid Chromatography (HPLC).
- Data on hematocrit, RBC transfusion volume, and feeding status were collected and correlated with IP measurements.
Main Results:
- RBC transfusions were more frequent and involved higher volumes in intervals preceding high intestinal permeability (IP > 0.05).
- Infants receiving RBC transfusions had a significantly increased risk of developing high IP.
- Exclusive breast milk feeding and increased post-menstrual age were associated with a reduced risk of high IP following RBC transfusion.
Conclusions:
- Both the number and volume of RBC transfusions are associated with subsequent high intestinal permeability in preterm infants.
- RBC transfusions may contribute to the impairment of the intestinal barrier in this vulnerable population.
- Optimizing feeding strategies, such as exclusive breast milk feeding, may be protective against transfusion-related IP changes.
Objective:
To determine the relationships of red blood cell (RBC) transfusion and enteral feeding to changes in intestinal permeability (IP) measured by the relative intestinal uptake of lactulose (La) and rhamnose (Rh) in preterm infants <33 wk gestation.
Design/Methods:
Infants 240-326wk gestation received La/Rh solution enterally on study days 1, 8 and 15.Urinary La/Rh ratio was measured by HPLC. Hematocrit preceding transfusion, total RBC transfusion volume, volume/kg, and feeding status during each study interval (birth-d1; d1-d8, and d8-d15) were determined.
Results:
Of the seventeen (40.5%) subjects who received≥1 transfusion during the study period, 12 (70.6%) infants were <28 wk gestation and 5 (29.4%) infants were≥28 wk gestation, p < 0.0001. Lower pre-transfusion hematocrit was observed in intervals preceding high IP (La/Rh > 0.05) than in intervals preceding low IP (La/Rh≤0.05) measurements (33 vs 35.8, p = 0.1051). RBC transfusions occurred more frequently in intervals preceding high IP than in intervals preceding low IP (26.8%; vs 8.3%, p = 0.0275) with 5-fold higher total RBC volume and volume/kg in intervals preceding any time point with high IP. RBC transfusion during an interval was associated with a three-fold increased risk of high IP (aOR 2.7; 95% C.I 0.564-12.814; p = 0.2143). Exclusive breast milk exposure and post-menstrual age reduced the risk for high IP following RBC transfusion.
Conclusions:
Both RBC transfusion number and volume was associated with subsequent high IP measurements in preterm infants <33 weeks gestation and potentially may contribute to impairment of the preterm intestinal barrier.
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