Department of Pediatrics, Neonatology Division, Emory University School of Medicine, Atlanta, Georgia; Department of Pathology, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia; Department of Pediatrics, Neonatology Division, University of Texas, Southwestern, Dallas, Texas; Rollins School of Public Health, Emory University, Atlanta, Georgia; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia; School of Nursing, Florida International University, Miami, Florida; Department of Pathology, Children's Healthcare of Atlanta Blood and Tissue Services, Atlanta, Georgia.
Transfusion. 2013 Nov;53(11):2650-8. doi: 10.1111/trf.12158. Epub 2013 Mar 11.
Recent evidence suggests that antecedent red blood cell (RBC) transfusions increase the risk for necrotizing enterocolitis (NEC), the most common gastrointestinal emergency encountered by very-low-birthweight (VLBW) infants. The underlying mechanism for this association is unknown. Altered oxygenation of the mesenteric vasculature during RBC transfusion has been hypothesized to contribute to NEC development and was investigated in this study.
Oxygenation patterns among four VLBW infants who developed transfusion-related NEC (TR-NEC) were compared to four VLBW infants with similar gestational age who were transfused but did not develop NEC (non-NEC). Cerebral and mesenteric patterns were recorded before, during, and 48 hours after RBC transfusion using near-infrared spectroscopy (NIRS) technology. Percentage change from mean baseline regional oxygen saturation values and cerebrosplanchnic oxygenation ratios were analyzed.
All TR-NEC infants (24-29 weeks' gestation; 705-1080 g) demonstrated greater variation in mesenteric oxygenation patterns surrounding transfusions than non-NEC infants (27.6-30 weeks' gestation; 980-1210 g). TR-NEC infants received larger mean volumes of total blood (27.75 ± 8.77 mL/kg) than non-NEC infants (15.25 ± 0.5 mL/kg).
Wide fluctuation and decreases in mesenteric oxygenation patterns are more pronounced in TR-NEC infants, especially before TR-NEC onset, compared to non-NEC infants. Greater total volume of infused blood was associated with TR-NEC in preterm infants. Using NIRS, larger prospective studies are needed to further evaluate potential risk factors for NEC in this high-risk population.
最近的证据表明，前置红细胞（RBC）输血会增加坏死性小肠结肠炎（NEC）的风险，这是极低出生体重（VLBW）婴儿最常见的胃肠道急症。这种关联的潜在机制尚不清楚。在 RBC 输血过程中，肠系膜血管的氧合改变被假设为导致 NEC 发展的原因，并在本研究中进行了研究。
将四名发生输血相关 NEC（TR-NEC）的 VLBW 婴儿的氧合模式与四名具有相似胎龄但未发生 NEC（非-NEC）的接受输血的 VLBW 婴儿进行比较。使用近红外光谱（NIRS）技术在 RBC 输血前、输血中和输血后 48 小时记录大脑和肠系膜的模式。分析从平均基线区域氧饱和度值和脑内脏氧合比的百分比变化。
所有 TR-NEC 婴儿（24-29 周胎龄；705-1080g）在输血周围的肠系膜氧合模式变化比非-NEC 婴儿（27.6-30 周胎龄；980-1210g）更大。TR-NEC 婴儿接受的总血量平均值（27.75±8.77mL/kg）大于非-NEC 婴儿（15.25±0.5mL/kg）。
与非-NEC 婴儿相比，TR-NEC 婴儿的肠系膜氧合模式波动更大且降低更为明显，尤其是在 TR-NEC 发作之前。输注的总血量增加与早产儿 TR-NEC 相关。使用 NIRS，需要更大的前瞻性研究来进一步评估这个高危人群中 NEC 的潜在危险因素。
