MONITORING OF THE CEREBRAL TISSUE SATURATION IN ANEMIA OF EXTREMELY PRETERM INFANTS

Abstract

Objectives. In this study we investigated if the cerebral oxygenation measurements before and after the packed red blood cell transfusions (PRBC) can answer the question: was transfusion beneficial? Can the measurements derived from NIRS (near infrared spectroscopy) be useful for the identification of more objective criteria for the transfusion guidelines? Patients and methods. This is a prospective observational study, performed in the period July 2017 – March 2018, in the 3th neonatal intensive care unit. It enrolled 44 preterm infants, with a weight ≤ 1250 g and gestational age ≤ 30 weeks, randomized by the PRBC transfusion in transfused group (n = 29) and non-transfused group (n = 15). The preterm infants that needed transfusion were NIRS monitored before (continuous monitoring 24 h), during and 24 h after the transfusion. The non-transfused patients were also monitored with cerebral regional pulse-oximetry at postnatal age, and under clinical conditions similar to the transfused group. Results. The values of the cerebral and systemic oximetry were comparable for the two groups when comparing the results before transfusion. Regarding the effects of transfusions, results showed a significant increase of cerebral tissue oxygenation (CrSO2) even during the 4 hours of transfusion, an effect maintained 24 hours following transfusion: postransfusional mean CrSO2 = 80±2, p value 0.019. Moreover, the values of the fractional cerebral tissue oxygen extraction begin to decrease during transfusion, and they remain low for the next 24 h as well 0.25±0.05 vs 0.15±0.02 – p value <0.013. Conclusions. PRBC transfusion in clinically stable very low birth weight preterm leads to the transient increase of CrSO2 and transient decrease of FTOE. Our data support the use of measurements derived from NIRS (FTOE) for the identification of the sub-clinical imbalance in O2 delivery and consumption as objective measurement in anemic preterm infants.

Keywords

• preterm infant anemia
• transfusion
• cerebral tissue saturation