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Effect of booster blood transfusions on oxygen utilization in infants with bronchopulmonary dysplasia
D C Alverson1, V H Isken, R S Cohen
1Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque 87131.
Insights
Booster transfusions improved oxygen transport and reduced oxygen consumption in infants with bronchopulmonary dysplasia. The greatest benefits were seen in infants with higher initial oxygen utilization, indicating a targeted physiological advantage.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Cardiovascular Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in premature infants.
- Oxygen dependency is common in BPD, leading to increased cardiopulmonary stress.
- Transfusion therapy is sometimes used, but its impact on oxygen metabolism is not fully understood.
Purpose of the Study:
- To evaluate the effect of packed erythrocyte transfusions on oxygen utilization and systemic oxygen transport in oxygen-dependent infants with BPD.
- To identify predictors of a positive physiological response to transfusion therapy.
Main Methods:
- Noninvasive measurement of oxygen consumption (VO2) and systemic oxygen transport (SOT) before and 24 hours after transfusion.
- Calculation of the coefficient of oxygen utilization (VO2/SOT).
- Pulsed Doppler ultrasonography for cardiac output, transcutaneous pulse oximetry for oxygen saturation.
Main Results:
- Oxygen utilization significantly decreased in all infants post-transfusion (p < 0.01).
- A greater reduction in oxygen utilization was observed in infants with higher baseline coefficients of oxygen utilization (r = -0.80, p < 0.01).
- Systemic oxygen transport increased (p < 0.01) and VO2 decreased (p < 0.02) post-transfusion.
Conclusions:
- Booster transfusions can improve systemic oxygen transport and reduce oxygen consumption in infants with BPD.
- Infants with higher initial oxygen utilization may experience greater physiological benefits from transfusions.
- Hemoglobin levels alone do not predict transfusion response in this population.
Abstract:
To assess the impact of booster transfusions on oxygen utilization in infants with bronchopulmonary dysplasia, we noninvasively measured oxygen consumption (VO2) and the variables of systemic oxygen transport (SOT) before and 24 hours after transfusion therapy in 10 oxygen-dependent infants with bronchopulmonary dysplasia. The infants had been born with a mean gestational age of 27.6 weeks and a mean birth weight of 0.88 kg. Study weight averaged 1.24 +/- 0.35 kg, and study age averaged 5.5 +/- 2.4 weeks. Requirements for fractional concentration of inspired oxygen averaged 0.41 +/- 0.15 to maintain an oxygen saturation of 0.93 +/- 0.02. The VO2 was measured by means of a commercially available analyzer through a flow-through circuit and pump connected to a hood or in line with the ventilator. Cardiac output was calculated by means of pulsed Doppler ultrasonography. Oxygen saturation was measured by means of transcutaneous pulse oximetry. The coefficient of oxygen utilization was calculated as VO2/SOT. Transfusion consisted of packed erythrocytes (10 ml/kg). Oxygen utilization fell in all subjects after transfusion (p less than 0.01), but it fell more substantially in subjects with higher coefficients of oxygen utilization (r = -0.80, p less than 0.01), suggesting a physiologic benefit in selected patients, particularly those with higher levels of oxygen utilization. There was also a significant increase in overall systemic oxygen transport (p less than 0.01) and decrease in VO2 (p less than 0.02). Hemoglobin levels alone did not correlate with overall systemic oxygen transport, VO2, or level of oxygen use before transfusion, and thus did not predict which subjects would have a physiologic benefit from transfusion as reflected by falls in oxygen utilization.