Red Blood Cell Transfusions Affect Intestinal and Cerebral Oxygenation Differently in Preterm Infants with and without Subsequent Necrotizing Enterocolitis

Abstract

Objective: To assess intestinal and cerebral oxygenation during and after red blood cell (RBC) transfusions in preterms with or without subsequent transfusion-associated necrotizing enterocolitis (TANEC).

Study design: In preterms of < 32 weeks' gestational age, we measured intestinal and cerebral regional tissue oxygen saturation (r_intSO₂, r_cSO₂) and their variabilities using near-infrared spectroscopy during and after transfusions. We compared eight infants who developed TANEC 6 to 48 hours after RBC transfusions with 16 controls.

Results: In TANEC infants, r_cSO₂ was lower during and after RBC transfusions than in controls, median (interquartile range) 55% (50-62) versus 72% (65-75), p < 0.01. There were no differences regarding r_intSO₂. Individual r_intSO₂ and r_cSO₂ ranges were smaller after transfusions in TANEC infants, 28% (9-36) versus 49% (40-65), p < 0.01, and 17% (14-33) versus 36% (26-57), p = 0.01, as was short-term r_intSO₂ variability. For each 10% higher r_cSO₂, the risk of developing TANEC decreased (odds ratio 0.09; 95% confidence interval 0.01-0.63). The smaller the r_intSO₂ range after transfusion, the higher the risk of developing TANEC.

Conclusion: In preterm infants lower r_cSO₂, but not r_intSO₂, values during and after RBC transfusions are associated with TANEC. Lower r_intSO₂ and r_cSO₂ variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC.