Blood transfusion effect on the respiratory pattern of preterm infants

Anemia may increase the risk of tissue hypoxia in preterm infants. This could lead to respiratory center depression and an increased risk for apnea. Heart rate and breathing pattern were recorded in 30 preterm infants (gestational age 30.0 +/- 2.3 weeks, postnatal age 46.6 +/- 20.8 days, and weight 1,438 +/- 266 g) before and after a transfusion of 10 mL/kg of packed RBCs. All infants were stable clinically, breathing room air, and free of prolonged apneic episodes. After transfusion, hematocrit levels increased from 27.0% +/- 2.5% to 35.8% +/- 4.7%. Heart rate decreased from 157.2 +/- 13.6 beats per minute to 148.4 +/- 13.9 beats per minute. There was no change in respiratory rate or BP. The duration of periodic breathing decreased significantly, as did the duration of the longest periodic breathing episode (P less than .01). The number of respiratory pauses lasting 5 to 10 seconds and the number of pauses lasting 11 to 20 seconds also decreased significantly (P less than .05). The total duration of respiratory pauses, excluding pauses during periodic breathing, were significantly lower after transfusion (P less than .05), as was the number of episodes of bradycardia. These results indicate that preterm infants have a more irregular breathing pattern while anemic than after correction of the anemia. The irregular breathing pattern is probably caused by mild hypoxic respiratory center depression.