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The relationship between erythrocyte transfusion in very preterm infants and inflammatory cytokines and morbidities:
Fatmakhanım Osmanova1, Ali Bulbul2, Evrim Kıray Bas2
1Department of Pediatrics, Division of Neonatology, Sisli Hamidiye Etfal Education and Research Hospital, Şişli/Istanbul, 34371, Turkey. fatima.osmanova11@gmail.com.
Insights
Red blood cell (RBC) transfusions in preterm infants showed increased vascular endothelial growth factor (VEGF) and decreased insulin-like growth factor-binding protein-3 (IGFBP-3). While major inflammatory cytokines remained unchanged, clinical sepsis was noted in some infants post-transfusion.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Immunology
Background:
- Assessing immunologic and inflammatory effects of red blood cell (RBC) transfusions in preterm infants is crucial.
- Preterm infants born at ≤32 weeks gestation are particularly vulnerable to transfusion complications.
Purpose of the Study:
- To evaluate serum cytokine level changes after RBC transfusion in preterm infants.
- To assess potential proinflammatory effects and associations with neonatal morbidities.
Main Methods:
- Prospective observational study of preterm infants (≤32 weeks gestation) receiving RBC transfusion.
- Serum levels of IL-1, IL-6, TNF-α, VEGF, melatonin, IGF-1, and IGFBP-3 were measured pre- and post-transfusion.
- Clinical outcomes including sepsis and respiratory support were monitored post-transfusion.
Main Results:
- RBC transfusion led to a significant increase in VEGF and a decrease in IGFBP-3.
- No significant changes were observed in major proinflammatory cytokines (IL-1, IL-6, TNF-α) or melatonin.
- Clinical sepsis occurred in 21.2% of infants within the first week, and respiratory support needs decreased over time.
Conclusions:
- RBC transfusion in preterm infants is associated with altered VEGF and IGFBP-3 levels, but not major inflammatory cytokines.
- Clinical sepsis and reduced respiratory support needs were observed, but causality cannot be inferred due to the lack of a control group.
- Further research with control groups is needed to establish causal relationships between RBC transfusion and clinical outcomes in preterm infants.
Background:
It is essential to assess not only the hematologic outcomes but also the immunologic and inflammatory consequences of RBC transfusion in preterm infants.
Aims:
This study aimed to evaluate changes in serum cytokine levels following red blood cell (RBC) transfusion in preterm infants born at ≤ 32 weeks of gestation and to assess their potential proinflammatory effects and associations with neonatal morbidities.
Materials And Methods:
This prospective, single-center observational study included preterm infants born at ≤ 32 weeks of gestation, aged > 7 days, who received RBC transfusion. Serum interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF), and melatonin were measured before and at 2 and 24 h after transfusion. Insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) were analyzed at 1, 2, and 3 weeks post-transfusion.
Results:
Thirty-three infants met the inclusion criteria. The mean gestational age was 27.4 ± 2.7 weeks, and the mean birth weight was 1016 ± 356 g. Following transfusion, the hematocrit increased from 28.3 ± 3.1% to 35.0 ± 3.8%. No significant post-transfusion changes were observed in IL-1, IL-6, TNF-α, melatonin, or IGF-1 levels. However, VEGF increased (p = 0.045) and IGFBP-3 decreased (p = 0.022) significantly. During follow-up, clinical sepsis was observed in 7 (21.2%), 4 (12.1%), and 1 (3.0%) infants at weeks 1, 2, and 3, respectively (p = 0.007). Respiratory support requirements decreased over time, particularly for non-invasive synchronized intermittent mandatory ventilation (p = 0.029).
Conclusions:
In this single-arm observational cohort, RBC transfusion was followed by increased VEGF and decreased IGFBP-3 levels, without significant changes in major proinflammatory cytokines. During follow-up, respiratory support requirements decreased and clinical sepsis was observed in a subset of infants. However, because no non-transfused control group was included, these clinical findings should be interpreted as descriptive and exploratory temporal observations rather than evidence of causality.
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