Regional tissue oxygenation and conventional indicators of red blood cell transfusion in anaemic preterm infants

BACKGROUND: It is unresolved whether low haemoglobin (Hb) and symptoms of anaemia reflect oxygen delivery-consumption imbalances (fractional tissue oxygen extraction [FTOE]). Here, we test whether pre-transfusion Hb and symptoms of anaemia correlate with pre-transfusion cerebral and splanchnic FTOE. METHODS: This prospective cohort study was carried out between Sept 1, 2014 and Nov 30, 2016 at Nepean Hospital, Sydney, Australia. The study enroled haemodynamically stable preterm infants: gestation <32 weeks; birth weight <1500 gs; postmenstrual age <37weeks, who received 15 mL/kg packed red blood cell transfusion (PRBCT) based on low Hb and symptoms of anaemia. FTOE was determined using simultaneous monitoring of near-infrared spectroscopy and pulse oximetry for 4 h before PRBCT. FINDINGS: The study enroled 29 infants born with a median gestation of 26.4 weeks (IQR 25.4–28.1), birth weight 922 g (655–1064), at postmenstrual age 33.6 weeks (31.7–34.9), and weight 1487 g (1110–1785). There was no significant correlation between Hb (median 97 g/L, IQR 87–100) and cerebral FTOE (r=–0.12, 95% CI –0.47 to 0.27; p = 0.54, n = 29) as well as splanchnic FTOE (r=–0.09, 95% CI –0.45 to 0.29; p = 0.64, n = 29). Median cerebral FTOE (p = 0.67) and splanchnic FTOE (p = 0.53) did not differ between symptomatic and asymptomatic groups. INTERPRETATION: Our preliminary findings suggest that pre-transfusion Hb and symptoms of anaemia might not accurately reflect oxygen delivery-consumption imbalances in both the brain and the gut. A lack of correlation with cerebral FTOE might be presumed to be due to the brain-sparing effect. However, the lack of correlation with splanchnic FTOE is more concerning. Hence, these results warrant larger studies incorporating FTOE along with the conventional criteria in the transfusion algorithm. FUNDING: The study was funded (for the purchase of NIRS sensors) by the Australian Women and Children's Research Foundation.