Martini Silvia, Spada Caterina, Aceti Arianna, Rucci Paola, Gibertoni Dino, Battistini Barbara, Arcuri Santo, Faldella Giacomo, Corvaglia Luigi
Neonatal Intensive Care Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Transfusion. 2020 Aug;60(8):1669-1675. doi: 10.1111/trf.15821. Epub 2020 May 1.
Preterm infants often require red blood cell (RBC) transfusions, which may impair splanchnic hemodynamics, thus predisposing to necrotizing enterocolitis (NEC). The aim of this study was to evaluate whether RBC transfusions alter splanchnic oxygenation patterns in response to enteral feeding in this population.
Preterm neonates (gestational age < 32 weeks and/or birth weight < 1500 g) requiring RBC transfusions for anemia underwent a 12-hour Near Infrared Spectroscopy monitoring of splanchnic (SrSO ) and cerebral (CrSO ) oxygenation, including the transfusion period, one feed before and one after. Splanchnic-cerebral oxygenation ratio (SCOR) was also calculated. Patterns of CrSO , SrSO , and SCOR changes from baseline (Δ) in response to feed before and after transfusion were analyzed.
Twenty neonates were enrolled; none of them developed any gastrointestinal complication within 48 hours after transfusion. Pre-transfusion ΔSrSO and ΔSCOR increased significantly in response to feeding; on the contrary, a significant post-prandial decrease of ΔSrSO and ΔSCOR occurred after transfusion (p < 0.05). No difference in pre- and post-transfusion ΔCrSO patterns was observed.
In preterm infants, RBC transfusions may alter splanchnic oxygenation response to enteral feeds. Whether these changes are involved in the pathogenesis of transfusion-associated NEC has to be evaluated in further larger trials.
早产儿常需要输注红细胞（RBC），这可能会损害内脏血流动力学，从而易患坏死性小肠结肠炎（NEC）。本研究的目的是评估RBC输注是否会改变该人群在肠内喂养时的内脏氧合模式。
因贫血需要输注RBC的早产新生儿（胎龄<32周和/或出生体重<1500g）接受了12小时的近红外光谱监测，监测内脏（SrSO）和脑（CrSO）氧合，包括输血期间、输血前一次喂养和输血后一次喂养。还计算了内脏-脑氧合比（SCOR）。分析了输血前后喂养时CrSO、SrSO和SCOR相对于基线（Δ）的变化模式。
纳入20例新生儿；输血后48小时内均未出现任何胃肠道并发症。输血前，喂养后ΔSrSO和ΔSCOR显著增加；相反，输血后餐后ΔSrSO和ΔSCOR显著下降（p<0.05）。输血前后ΔCrSO模式无差异。
在早产儿中，RBC输注可能会改变肠内喂养时的内脏氧合反应。这些变化是否参与输血相关NEC的发病机制，有待进一步更大规模的试验评估。
