Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
Transfusion. 2020 Mar;60(3):466-472. doi: 10.1111/trf.15680. Epub 2020 Jan 26.
Understanding factors that impact tissue oxygen extraction may guide red blood cell (RBC) transfusion decision making in preterm infants. Our objective was to assess the influence of enteral feeding and anemia on cerebral and mesenteric oxygen saturation (Csat and Msat) and fractional tissue oxygen extraction (cFTOE and mFTOE) over the entire time course of RBC transfusion.
Preterm, very low-birth-weight infants receiving RBC transfusions at a single center were enrolled. Near-infrared spectroscopy sensors measured Csat and Msat levels from an hour before transfusion to 24 hours after. During this period, changes in Csat, Msat, cFTOE, and mFTOE were described, and their association with enteral feeding status and pretransfusion degree of anemia were assessed using generalized estimating equations.
RBC transfusion data from 31 preterm infants were included. Infants receiving enteral feeds exhibited lower pretransfusion Msat. Infants with pretransfusion hematocrit greater than 30% exhibited higher pretransfusion Csat and lower pretransfusion cFTOE. Such differences in baseline measurements persisted through 24 hours after transfusion. However, no statistically significant differences in oxygenation measures over time by enteral feeding or anemia status were identified.
Compared to NPO, enteral feeding was associated with lower Msat; anemia (hematocrit ≤30%) was associated with lower Csat and higher cFTOE. Over the time course of RBC transfusion, trajectories of Csat, Msat, cFTOE and mFTOE did not differ by enteral feeding or anemia status.
了解影响组织氧提取的因素可能有助于指导早产儿红细胞（RBC）输血决策。我们的目的是评估肠内喂养和贫血对脑和肠系膜氧饱和度（Csat 和 Msat）以及组织氧摄取分数（cFTOE 和 mFTOE）的影响，这些影响贯穿 RBC 输血的整个过程。
在一家中心接受 RBC 输血的早产儿、极低出生体重儿被纳入研究。近红外光谱传感器在输血前 1 小时至输血后 24 小时测量 Csat 和 Msat 水平。在此期间，描述了 Csat、Msat、cFTOE 和 mFTOE 的变化，并使用广义估计方程评估其与肠内喂养状态和输血前贫血程度的关系。
纳入了 31 名接受 RBC 输血的早产儿的输血数据。接受肠内喂养的婴儿在输血前的 Msat 较低。输血前红细胞压积大于 30%的婴儿在输血前 Csat 较高，而 cFTOE 较低。这种基线测量的差异在输血后 24 小时内持续存在。然而，通过肠内喂养或贫血状态，在氧合指标上没有发现随时间变化的统计学显著差异。
与禁食相比，肠内喂养与 Msat 降低相关；贫血（红细胞压积≤30%）与 Csat 降低和 cFTOE 升高相关。在 RBC 输血的过程中，Csat、Msat、cFTOE 和 mFTOE 的轨迹不因肠内喂养或贫血状态而不同。
