Aktas Selma, Ergenekon Ebru, Ozcan Ebru, Aksu Meltem, Unal Sezin, Hirfanoglu Ibrahim M, Turkyilmaz Canan, Onal Esra, Koc Esin, Atalay Yildiz
Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey.
J Paediatr Child Health. 2019 Oct;55(10):1209-1213. doi: 10.1111/jpc.14378. Epub 2019 Jan 10.
Most of the preterm infants are transfused at least once during their stay in the neonatal intensive care unit (NICU). The aims of this study were to demonstrate if packed red blood cell (pRBC) transfusion modulates regional (cerebral, abdominal, renal) tissue oxygen saturation measured by near-infrared spectroscopy (NIRS) and to demonstrate if we can use NIRS to guide transfusion decisions in neonates.
A multi-probe NIRS device was applied to anaemic preterm infants of gestational age <33 weeks for 30-60 min before and 24 h after pRBC transfusion. We evaluated the results separately in the subgroup with a pre-transfusion haemoglobin (Hb) < 8 g/dL. Cerebral, abdominal and renal tissue oxygen saturation (rSO ) and abdominal/cerebral, abdominal/renal and renal/cerebral rSO ratios before and 24 h after transfusion were compared.
There was no significant difference in cerebral rSO and abdominal/renal rSO ratios before and 24 h after transfusion, but abdominal and renal rSO and abdominal/cerebral and renal/cerebral rSO ratios at the 24th h following transfusion increased significantly. This increase was observed in the subgroup with pre-transfusion Hb < 8 g/dL. Although statistically significant, the increase in renal oxygenation was within the limits of variability.
The increase in tissue oxygenation in abdominal region after pRBC transfusion suggests decreased tissue oxygenation of intestines during severe anaemia despite cerebral oxygenation being maintained at that particular Hb level. The impact of the increase on renal oxygenation with pRBC transfusion is unclear and might need further investigation. Increase in abdominal rSO may cause reperfusion injury, oxidative damage and trigger necrotising enterocolitis.
大多数早产儿在新生儿重症监护病房（NICU）住院期间至少接受一次输血。本研究的目的是证明浓缩红细胞（pRBC）输血是否会调节通过近红外光谱（NIRS）测量的局部（脑、腹部、肾）组织氧饱和度，并证明我们是否可以使用NIRS指导新生儿的输血决策。
将多探头NIRS设备应用于胎龄<33周的贫血早产儿，在pRBC输血前30 - 60分钟和输血后24小时进行检测。我们对输血前血红蛋白（Hb）<8 g/dL的亚组分别评估结果。比较输血前和输血后24小时的脑、腹部和肾组织氧饱和度（rSO₂）以及腹部/脑、腹部/肾和肾/脑rSO₂比值。
输血前和输血后24小时的脑rSO₂以及腹部/肾rSO₂比值无显著差异，但输血后24小时的腹部和肾rSO₂以及腹部/脑和肾/脑rSO₂比值显著增加。在输血前Hb<8 g/dL的亚组中观察到了这种增加。尽管具有统计学意义，但肾氧合的增加仍在变异范围内。
pRBC输血后腹部组织氧合增加表明，在严重贫血期间，尽管在该特定Hb水平下脑氧合得以维持，但肠道组织氧合降低。pRBC输血对肾氧合增加的影响尚不清楚，可能需要进一步研究。腹部rSO₂的增加可能会导致再灌注损伤、氧化损伤并引发坏死性小肠结肠炎。
