The effect of haemoglobin and blood transfusion on preterm infant gut perfusion and injury

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Abstract

Introduction

There is significant uncertainty regarding the role that anaemia or red blood cell transfusion (RBCT) plays in the development of gut injury in preterm infants. This study evaluated Near Infrared Spectroscopy (NIRS) together with a range of known biomarkers of gut inflammation to identify their relationship with anaemia and RBCT.

Method

A prospective observational study of preterm infants born at <30 weeks gestation was conducted from birth until either 36 weeks post conceptional age or discharge home. Gut perfusion and biomarkers of gut injury were assessed weekly by: 60 min NIRS measurements (splanchnic tissue oxygenation index [sTOI] and fractional tissue oxygenation extraction [sFTOE]); stool calprotectin; urine intestinal and liver fatty acid binding proteins (I-FABPs and L-FABPs); and trefoil factor 3 (TFF-3). Exclusion criteria included Fetal Growth Restriction (FGR), and abnormal antenatal Dopplers. Haemoglobin (Hb) levels were measured in parallel with NIRS measurements. NIRS, together with urine and stool biomarkers of gut injury, were evaluated up to 72 h pre/post RBCT and pre/post measurements compared.

Results

Forty-eight infants were studied. Median (range) gestational age was 26 ⁺ ³ (23 ⁺ ⁰ to 29 ⁺ ⁶) weeks and birthweight 883.5 g (460–1,600). Seven (14.6%) infants developed ≥ Bells stage 2 NEC. 28 (58.3%), 5 (10.4%) and 24 (50%) infants had ECHO confirmed PDA, haemorrhagic parenchymal infarct (HPI) and IVH respectively. There were 22 episodes of sepsis. Infants were in the study for a median of 7.3 (1–13) weeks. There was no significant association between Hb divided into three categories (<80 g/L, 80–111.9 g/L and ≥120 g/L) or continuous values and sTOI, sFTOE or any of the gut injury biomarkers measured ( p > 0.05). 283 RBCTs were administered; 117 (41.3%) within the first two weeks of life. Pre and post blood transfusion changes in splanchnic NIRS oxygenation, urine and stool gut injury biomarkers were measured in 165, 195 and 175 episodes of RBCT respectively. There was no significant post RBCT changes in splanchnic NIRS or gut injury biomarker levels ( p > 0.05). However, post RBCT calprotectin was significantly reduced during the first 14 days of life (mean difference −114%, CI −185 to −42 & p 0.002).

Conclusion

There was no association between anaemia or RBCT with NIRS measurements of tissue oxygen saturation and biomarkers of intestinal inflammation or gut injury in preterm infants enrolled in this study. Further studies with standardised methods of examining the relationship between anaemia, RBCT and gut injury are needed.

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Most cited references 86

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Principles, techniques, and limitations of near infrared spectroscopy.

Marco Ferrari, Leonardo Mottola, Valentina Quaresima (2004)

In the last decade the study of the human brain and muscle energetics underwent a radical change, thanks to the progressive introduction of noninvasive techniques, including near-infrared (NIR) spectroscopy (NIRS). This review summarizes the most recent literature about the principles, techniques, advantages, limitations, and applications of NIRS in exercise physiology and neuroscience. The main NIRS instrumentations and measurable parameters will be reported. NIR light (700-1000 m) penetrates superficial layers (skin, subcutaneous fat, skull, etc.) and is either absorbed by chromophores (oxy- and deoxyhemoglobin and myoglobin) or scattered within the tissue. NIRS is a noninvasive and relatively low-cost optical technique that is becoming a widely used instrument for measuring tissue O2 saturation, changes in hemoglobin volume and, indirectly, brain/muscle blood flow and muscle O2 consumption. Tissue O2 saturation represents a dynamic balance between O2 supply and O2 consumption in the small vessels such as the capillary, arteriolar, and venular bed. The possibility of measuring the cortical activation in response to different stimuli, and the changes in the cortical cytochrome oxidase redox state upon O2 delivery changes, will also be mentioned.

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Near-infrared spectroscopy as an index of brain and tissue oxygenation.

J.M. Murkin, M Arango (2009)

Continuous real-time monitoring of the adequacy of cerebral perfusion can provide important therapeutic information in a variety of clinical settings. The current clinical availability of several non-invasive near-infrared spectroscopy (NIRS)-based cerebral oximetry devices represents a potentially important development for the detection of cerebral ischaemia. In addition, a number of preliminary studies have reported on the application of cerebral oximetry sensors to other tissue beds including splanchnic, renal, and spinal cord. This review provides a synopsis of the mode of operation, current limitations and confounders, clinical applications, and potential future uses of such NIRS devices.

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Bifidobacterium breve BBG-001 in very preterm infants: a randomised controlled phase 3 trial.

Kate Costeloe, Pollyanna Hardy, Edmund Juszczak … (2016)

Probiotics may reduce necrotising enterocolitis and late-onset sepsis after preterm birth. However, there has been concern about the rigour and generalisability of some trials and there is no agreement about whether or not they should be used routinely. We aimed to test the effectiveness of the probiotic Bifidobacterium breve BBG-001 to reduce necrotising enterocolitis, late-onset sepsis, and death in preterm infants.

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Author and article information

Contributors

Claire Howarth: URI : https://loop.frontiersin.org/people/1886890/overviewRole: Role: Role: Role: Role: Role: Role:

Christian Mifsud: URI : https://loop.frontiersin.org/people/2820355/overviewRole: Role:

Jayanta Banerjee: URI : https://loop.frontiersin.org/people/1954977/overviewRole: Role: Role: Role:

Simon Eaton: URI : https://loop.frontiersin.org/people/866282/overviewRole: Role: Role:

Terence Leung: URI : https://loop.frontiersin.org/people/1879365/overviewRole: Role: Role:

Paul Fleming: URI : https://loop.frontiersin.org/people/2754196/overviewRole: Role: Role:

Joan Morris: URI : https://loop.frontiersin.org/people/1180914/overviewRole: Role: Role:

Narendra Aladangady: URI : https://loop.frontiersin.org/people/1646322/overviewRole: Role: Role: Role: Role:

Journal

Journal ID (nlm-ta): Front Pediatr

Journal ID (iso-abbrev): Front Pediatr

Journal ID (publisher-id): Front. Pediatr.

Title: Frontiers in Pediatrics

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-2360

Publication date (Electronic): 22 November 2024

Publication date Collection: 2024

Volume: 12

Electronic Location Identifier: 1440537

Affiliations

[ ¹ ]Neonatal Unit, Homerton Healthcare NHS Foundation Trust and Queen Mary University of London , London, England

[ ² ]Great Ormond Street Institute of Child Health, University College London (UCL) , London, England

[ ³ ]School of Science and Technology, Centre for Health, Ageing and Understanding Disease (CHAUD), Nottingham Trent University , Nottingham, England

[ ⁴ ]Neonatal Unit, Imperial College Healthcare NHS Trust and Imperial College London , London, England

[ ⁵ ]Department of Medical Physics and Biomedical Engineering, University College London , London, England

[ ⁶ ]Population Health Research Institute, St George’s University of London, London , England

Author notes

Edited by: Xiaocai Yan, Ann & Robert H. Lurie Children’s Hospital of Chicago, United States

Reviewed by: Darja Paro-Panjan, University Children’s Hospital Ljubljana, Slovenia

Rakhee Bowker, Rush University, United States

[* ] Correspondence: Narendra Aladangady n.aladangady@ 123456nhs.net

Article

DOI: 10.3389/fped.2024.1440537

PMC ID: 11620877

PubMed ID: 39649403

SO-VID: e6d2789b-c199-44e3-81c3-85e97e4732d0

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 29 May 2024

Date accepted : 28 October 2024

Page count

Figures: 2, Tables: 7, Equations: 0, References: 87, Pages: 14, Words: 0

Funding

Funded by: Barts Charity Grant Award

Award ID: MGU0388

Funded by: Barts Charity Grant

Funded by: IHR Biomedical Research Centre at Great Ormond Street Hospital

Funded by: UCL Great Ormond Street Institute of Child Health

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by a Barts Charity Grant Award (Grant reference number MGU0388). The authors have no financial relationships relevant to this article to disclose. Dr Howarth was funded through the Barts Charity Grant, but none of the other authors had a financial relationship with the charity or the fund. Dr Eaton acknowledges support from NIHR Biomedical Research Centre at Great Ormond Street Hospital and UCL Great Ormond Street Institute of Child Health.

Custom metadata

section-at-acceptance Neonatology

Keywords: haemoglobin,blood transfusion,preterm infants,gut perfusion,gut injury,nec

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Keywords: haemoglobin, blood transfusion, preterm infants, gut perfusion, gut injury, nec

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The effect of haemoglobin and blood transfusion on preterm infant gut perfusion and injury

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Abstract

Introduction

Method

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Most cited references 86

Principles, techniques, and limitations of near infrared spectroscopy.

Near-infrared spectroscopy as an index of brain and tissue oxygenation.

Bifidobacterium breve BBG-001 in very preterm infants: a randomised controlled phase 3 trial.

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