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Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion

BACKGROUND: It is well established that counter-regulation to hypoxia follows a hierarchical pattern, with brain-sparing in preference to peripheral tissues. In contrast, it is unknown if the same hierarchical sequence applies to recovery from hypoxia after correction of anemia with packed red blood...

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Autores principales: Balegar V., Kiran Kumar, Jayawardhana, Madhuka, Martin, Andrew J., de Chazal, Philip, Nanan, Ralph Kay Heinrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9299358/
https://www.ncbi.nlm.nih.gov/pubmed/35857790
http://dx.doi.org/10.1371/journal.pone.0271563
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author Balegar V., Kiran Kumar
Jayawardhana, Madhuka
Martin, Andrew J.
de Chazal, Philip
Nanan, Ralph Kay Heinrich
author_facet Balegar V., Kiran Kumar
Jayawardhana, Madhuka
Martin, Andrew J.
de Chazal, Philip
Nanan, Ralph Kay Heinrich
author_sort Balegar V., Kiran Kumar
collection PubMed
description BACKGROUND: It is well established that counter-regulation to hypoxia follows a hierarchical pattern, with brain-sparing in preference to peripheral tissues. In contrast, it is unknown if the same hierarchical sequence applies to recovery from hypoxia after correction of anemia with packed red blood cell transfusion (PRBCT). OBJECTIVE: To understand the chronology of cerebral and splanchnic tissue oxygenation resulting after correction of anemia by PRBCT in preterm infants using near-infrared spectroscopy (NIRS). DESIGN: Prospective cohort study. SETTING: Neonatal intensive care. PATIENTS INCLUDED: Haemodynamically stable infants: <32 weeks gestation, <37weeks postmenstrual age, <1500 grams birth weight; and ≥120 mL/kg/day feeds tolerated. INTERVENTION: PRBCT at 15 mL/Kg over 4 hours. MAIN OUTCOME MEASURES: Transfusion-associated changes were determined by comparing the 4-hour mean pre-transfusion cerebral and splanchnic fractional tissue oxygen extraction (FTOEc0; FTOEs0) with hourly means during (FTOEc1-4; FTOEs1-4) and for 24 hours after PRBCT completion (FTOEc5-28; FTOEs5-28). RESULTS: Of 30 enrolled infants, 14[46.7%] male; median[IQR] birth weight, 923[655–1064]g; gestation, 26.4[25.5–28.1]weeks; enrolment weight, 1549[1113–1882]g; and postmenstrual age, 33.6[32.4–35]weeks, 1 infant was excluded because of corrupted NIRS data. FTOEc significantly decreased during and for 24 hours after PRBCT (p < 0.001), indicating prompt improvement in cerebral oxygenation. In contrast, FTOEs showed no significant changes during and after PRBCT (p>0.05), indicating failure of improvement in splanchnic oxygenation. CONCLUSION: Improvement in regional oxygenation after PRBCT follows the same hierarchical pattern with a prompt improvement of cerebral but not splanchnic tissue oxygenation. We hypothesise that this hierarchical recovery may indicate continued splanchnic hypoxia in the immediate post-transfusion period and vulnerability to transfusion-associated necrotizing enterocolitis (TANEC). Our study provides a possible mechanistic underpinning for TANEC and warrants future randomised controlled studies to stratify its prevention.
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spelling pubmed-92993582022-07-21 Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion Balegar V., Kiran Kumar Jayawardhana, Madhuka Martin, Andrew J. de Chazal, Philip Nanan, Ralph Kay Heinrich PLoS One Research Article BACKGROUND: It is well established that counter-regulation to hypoxia follows a hierarchical pattern, with brain-sparing in preference to peripheral tissues. In contrast, it is unknown if the same hierarchical sequence applies to recovery from hypoxia after correction of anemia with packed red blood cell transfusion (PRBCT). OBJECTIVE: To understand the chronology of cerebral and splanchnic tissue oxygenation resulting after correction of anemia by PRBCT in preterm infants using near-infrared spectroscopy (NIRS). DESIGN: Prospective cohort study. SETTING: Neonatal intensive care. PATIENTS INCLUDED: Haemodynamically stable infants: <32 weeks gestation, <37weeks postmenstrual age, <1500 grams birth weight; and ≥120 mL/kg/day feeds tolerated. INTERVENTION: PRBCT at 15 mL/Kg over 4 hours. MAIN OUTCOME MEASURES: Transfusion-associated changes were determined by comparing the 4-hour mean pre-transfusion cerebral and splanchnic fractional tissue oxygen extraction (FTOEc0; FTOEs0) with hourly means during (FTOEc1-4; FTOEs1-4) and for 24 hours after PRBCT completion (FTOEc5-28; FTOEs5-28). RESULTS: Of 30 enrolled infants, 14[46.7%] male; median[IQR] birth weight, 923[655–1064]g; gestation, 26.4[25.5–28.1]weeks; enrolment weight, 1549[1113–1882]g; and postmenstrual age, 33.6[32.4–35]weeks, 1 infant was excluded because of corrupted NIRS data. FTOEc significantly decreased during and for 24 hours after PRBCT (p < 0.001), indicating prompt improvement in cerebral oxygenation. In contrast, FTOEs showed no significant changes during and after PRBCT (p>0.05), indicating failure of improvement in splanchnic oxygenation. CONCLUSION: Improvement in regional oxygenation after PRBCT follows the same hierarchical pattern with a prompt improvement of cerebral but not splanchnic tissue oxygenation. We hypothesise that this hierarchical recovery may indicate continued splanchnic hypoxia in the immediate post-transfusion period and vulnerability to transfusion-associated necrotizing enterocolitis (TANEC). Our study provides a possible mechanistic underpinning for TANEC and warrants future randomised controlled studies to stratify its prevention. Public Library of Science 2022-07-20 /pmc/articles/PMC9299358/ /pubmed/35857790 http://dx.doi.org/10.1371/journal.pone.0271563 Text en © 2022 Balegar V. et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Balegar V., Kiran Kumar
Jayawardhana, Madhuka
Martin, Andrew J.
de Chazal, Philip
Nanan, Ralph Kay Heinrich
Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion
title Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion
title_full Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion
title_fullStr Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion
title_full_unstemmed Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion
title_short Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion
title_sort hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9299358/
https://www.ncbi.nlm.nih.gov/pubmed/35857790
http://dx.doi.org/10.1371/journal.pone.0271563
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