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The effect of blood transfusion on cerebral hemodynamics in preterm infants
Author(s) -
Koyano Kosuke,
Kusaka Takashi,
Nakamura Shinji,
Nakamura Makoto,
Konishi Yukihiko,
Miki Takanori,
Ueno Masaki,
Yasuda Saneyuki,
Okada Hitoshi,
Nishida Tomoko,
Isobe Kenichi,
Itoh Susumu
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2012.03953.x
Subject(s) - medicine , hematocrit , gestational age , anemia , anesthesia , hemodynamics , blood volume , blood transfusion , hemoglobin , exchange transfusion , birth weight , low birth weight , pediatrics , surgery , pregnancy , genetics , biology
Background Anemia of prematurity commonly occurs in infants with very low birth weight; blood transfusion is an important treatment. However, there is no clear evidence to support the criteria currently widely used, based on blood hemoglobin (b Hb ) and hematocrit indices. Previous studies showed that overtransfusion or a low threshold for transfusion could induce complications or neurologic sequelae, respectively. We hypothesized that a cerebral hemodynamic index may provide an appropriate criterion for determining the need for transfusion in anemic preterm infants. Study Design and Methods We used near‐infrared time‐resolved spectroscopy to measure cerebral hemoglobin oxygen saturation ( ScO 2 ) and cerebral blood volume ( CBV ) before and after transfusion in 19 infants (24 measurements) with anemia of prematurity. The median gestational age was 27 weeks 0 days, median birth weight was 751 g, and median postconceptual age at transfusion was 30 weeks 4 days. Results b Hb levels before and after transfusion (mean ± SD ) were 9.3 ± 1.4 and 13.7 ± 1.3 g/ dL , respectively. After transfusion, CBV significantly decreased from 2.63 ± 0.60 to 2.13 ± 0.26 mL /100 g of brain, and ScO 2 significantly increased from 72.8 ± 4.3% to 74.7 ± 4.2%. Conclusion After transfusion, CBV changes were significantly greater with low compared to high pretransfusion Hb levels. This reflected the physiologic response to severe anemia in premature infants, which is to increase CBV and decrease ScO 2 . Therefore, CBV and ScO 2 may be useful markers for determining the need for transfusion in very‐low‐birth‐weight infants.