Mintzer J P, Parvez B, Chelala M, Alpan G, LaGamma E F
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stony Brook Children's Hospital, Stony Brook, NY, USA.
Department of Pediatrics, Division of Newborn Medicine, The Regional Neonatal Intensive Care Unit, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
J Neonatal Perinatal Med. 2014 Jan 1;7(2):89-100. doi: 10.3233/NPM-1477213.
We sought to characterize the effects of "booster" packed red blood cell transfusions on multisite regional oxygen saturation in very low birth weight neonates during the first postnatal week and to examine the utility of fractional tissue oxygen extraction as an estimate of tissue oxygenation adequacy.
Data were collected in an observational near-infrared spectroscopy (NIRS) pilot survey of 500-1250 g neonates during the first postnatal week. A before-after analysis of "booster" transfusions, defined as empiric 15 mL/kg transfusion following 10 mL/kg cumulative phlebotomy losses, was conducted upon cardiopulmonary, laboratory, and spectroscopy data.
Ten neonates (gestational age 26 ± 0 wk; birth weight 879 ± 49 g) received 14 transfusions at 3 ± 0 postnatal days. Mean hematocrit increased from 35.2 ± 1.2 to 38.5 ± 1.2 % (P < 0.05) following transfusion; pH, base deficit, lactate, creatinine, and cardiopulmonary parameters were unchanged. Cerebral, renal, and splanchnic tissue oxygenation increased 10, 18, and 16%, with concomitant decreases in calculated oxygen extraction of 27, 30, and 9% (all P < 0.05), consistent with enhanced tissue oxygenation. These findings were not observed in a non-transfused comparison group of nine patients.
"Booster" transfusions improved indices of regional tissue oxygenation while no departures were observed in conventional cardiovascular assessments. We speculate that NIRS-derived oxygenation parameters can provide an objective, graded, and continuous estimate of oxygen delivery-consumption balance not evident using standard monitoring techniques.
我们试图描述“强化”红细胞输血对极低出生体重儿出生后第一周多部位局部氧饱和度的影响，并检验组织氧提取分数作为组织氧合充足性评估指标的实用性。
在一项针对出生体重500 - 1250g新生儿出生后第一周的观察性近红外光谱（NIRS）初步调查中收集数据。对“强化”输血（定义为在累计放血10mL/kg后经验性输注15mL/kg）前后的心肺、实验室和光谱数据进行分析。
10名新生儿（胎龄26±0周；出生体重879±49g）在出生后3±0天接受了14次输血。输血后平均血细胞比容从35.2±1.2%升至38.5±1.2%（P<0.05）；pH值、碱缺失、乳酸、肌酐和心肺参数无变化。脑、肾和内脏组织氧合分别增加了10%、18%和16%，同时计算得出的氧提取率分别降低了27%、30%和9%（均P<0.05），这与组织氧合增强一致。在9名未输血的对照组患者中未观察到这些结果。
“强化”输血改善了局部组织氧合指标，而传统心血管评估未发现异常。我们推测，NIRS得出的氧合参数可以提供一个客观、分级且连续的氧输送 - 消耗平衡评估，这是标准监测技术所无法体现的。
