Journal article
Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants: A Secondary Near-Infrared Spectroscopy Study of the Transfusion of Prematures Randomized Clinical Trial (TOP NIRS)
JAMA network open, Vol.6(9), e2334889
09/05/2023
DOI: 10.1001/jamanetworkopen.2023.34889
PMCID: PMC10514737
PMID: 37733345
Abstract
Importance Preterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes.
Objective To determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age.
Design, Setting, and Participants This was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022.
Interventions Near-infrared spectroscopy monitoring of Csat and Msat.
Main Outcomes and Measures Primary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score <85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment.
Results A total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower–hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher–hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO2) in either group (0.2% vs −0.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03).
Conclusions and Relevance In this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO2. Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia.
Details
- Title: Subtitle
- Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants: A Secondary Near-Infrared Spectroscopy Study of the Transfusion of Prematures Randomized Clinical Trial (TOP NIRS)
- Creators
- Valerie Y. Chock - Lucile Packard Children's HospitalHaresh Kirpalani - University of PennsylvaniaEdward F. Bell - University of IowaSylvia Tan - RTI InternationalSusan R. Hintz - Lucile Packard Children's HospitalM. Bethany Ball - University of IowaEmily Smith - RTI InternationalAbhik Das - RTI InternationalYvonne C. Loggins - Children's Healthcare of AtlantaBeena G. Sood - Wayne State UniversityLina F. Chalak - The University of Texas Southwestern Medical CenterMyra H. Wyckoff - The University of Texas Southwestern Medical CenterStephen D. Kicklighter - WakeMedKathleen A. Kennedy - The University of Texas Health Science Center at HoustonRavi M. Patel - Children's Healthcare of AtlantaWaldemar A. Carlo - University of Alabama at BirminghamKaren J. Johnson - University of IowaKristi L. Watterberg - University of New MexicoPablo J. Sánchez - Nationwide Children's HospitalAbbot R. Laptook - Brown UniversityRuth B. Seabrook - Nationwide Children's HospitalC. Michael Cotten - Duke UniversityToni Mancini - University of PennsylvaniaGregory M. Sokol - Indiana University – Purdue University IndianapolisRobin K. Ohls - University of New MexicoAnna Maria Hibbs - Case Western Reserve UniversityBrenda B. Poindexter - Cincinnati Children's Hospital Medical CenterAnne Marie Reynolds - Women & Children's Hospital of BuffaloSara B. DeMauro - Children's Hospital of PhiladelphiaSanjay Chawla - Wayne State UniversityMariana Baserga - University of UtahMichele C. Walsh - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentRosemary D. Higgins - Florida Gulf Coast UniversityKrisa P. Van Meurs - Stanford UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- JAMA network open, Vol.6(9), e2334889
- Publisher
- American Medical Association
- DOI
- 10.1001/jamanetworkopen.2023.34889
- PMID
- 37733345
- PMCID
- PMC10514737
- ISSN
- 2574-3805
- eISSN
- 2574-3805
- Grant note
- National Center for Advancing Translational Sciences Medtronic National Center for Research Resources National Institutes of Health National Heart, Lung, and Blood Institute Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Alternative title
- Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants
- Language
- English
- Date published
- 09/05/2023
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984469059802771
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