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The short-term effects of RBC transfusions on intestinal injury in preterm infants
Willemien S Kalteren1, Arend F Bos2, Klasien A Bergman2
1Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. w.s.kalteren@umcg.nl.
Insights
Red blood cell (RBC) transfusions in preterm infants increase oxidative stress and intestinal injury markers. Lower splanchnic oxygenation variability post-transfusion is linked to these adverse effects, potentially indicating early stages of necrotizing enterocolitis.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Biomarker Research
Background:
- Anemic preterm infants often require red blood cell (RBC) transfusions.
- RBC transfusions may lead to adverse intestinal effects in neonates.
- Understanding these effects is crucial for improving infant care.
Purpose of the Study:
- To investigate the short-term effects of RBC transfusions on preterm infants.
- To assess for signs of oxidative stress and intestinal injury.
- To explore the relationship between transfusion, oxygenation, and gut health.
Main Methods:
- Prospective study of preterm infants (gestational age < 32 weeks).
- Measurement of urinary 8-isoprostane and intestinal fatty acid-binding protein (I-FABP) before and after RBC transfusion.
- Simultaneous assessment of splanchnic oxygen saturation (rsSO2) and its variability.
Main Results:
- RBC transfusions led to increased urinary 8-isoprostane and I-FABP levels.
- The increase in biomarkers was more pronounced in infants who developed necrotizing enterocolitis (NEC).
- Lower rsSO2 variability correlated with higher biomarker levels post-transfusion.
Conclusions:
- Preterm RBC transfusions are associated with oxidative stress and intestinal injury.
- Reduced splanchnic oxygenation variability may play a role in transfusion-related gut issues.
- These findings suggest a potential early pathway for transfusion-associated NEC.
Background:
Anemic preterm infants may require red blood cell (RBC) transfusions to maintain sufficient oxygen supply to vital organs. Transfusion treatment, however, may have adverse intestinal effects. We aimed to investigate the short-term effects of RBC transfusions, hypothesizing to find signs of oxidative stress and intestinal injury, possibly related to levels of splanchnic (re-)oxygenation.
Methods:
We prospectively included preterm infants (gestational age < 32 weeks). We measured urinary biomarkers for oxidative stress (8-isoprostane) and intestinal cell injury (intestinal fatty acid-binding protein, I-FABP) shortly before and after RBC transfusion. Splanchnic oxygen saturation (rsSO2) and rsSO2 variability were assessed simultaneously.
Results:
Twenty-nine preterm infants received 58 RBC transfusions at various postnatal ages. Six of them developed necrotizing enterocolitis (NEC) after transfusion. Urinary 8-isoprostane and I-FABP increased following RBC transfusion (median 282-606 pg/ml and 4732-6968 pg/ml, p < 0.01), more pronounced in infants who developed NEC. Change in I-FABP correlated with change in 8-isoprostane (rho = 0.623, p < 0.01). Lower rsSO2 variability, but not higher mean rsSO2 was associated with higher 8-isoprostane and I-FABP levels after transfusion.
Conclusions:
Preterm RBC transfusions are associated with concomitant signs of oxidative stress and intestinal injury, parallel with lower variability in splanchnic oxygenation. This may represent the early pathogenetic process of transfusion-associated NEC.
Impact:
Red blood cell (RBC) transfusions in preterm infants are associated with a near 2-fold increase in urinary biomarkers for oxidative stress (8-isoprostane) and intestinal cell injury (intestinal fatty acid-binding protein, I-FABP). Magnitude of change in I-FABP strongly correlated with the magnitude of 8-isoprostane change, suggesting a role for oxidative stress in the pathogenesis of intestinal injury. Lower splanchnic oxygen saturation variability following RBC transfusion was associated with higher 8-isoprostane and I-FABP levels. Loss of splanchnic variability after RBC transfusion may result from increased oxidative stress and its concomitant intestinal injury, possibly representing the early pathogenetic process of transfusion-associated necrotizing enterocolitis.
