The Efficacy of Erythrocyte Transfusion in Very Low Birth Weight Infants with Premature Anemia

Yıl 2023, Cilt: 17 Sayı: 3, 187 - 193, 29.05.2023

Aybüke Yazıcı , Betül Siyah , Ahmet Serkan Özcan , Sevim Ünal

https://doi.org/10.12956/tchd.1204367

Öz

Objective: This study aimed to determine the clinical efficacy of erythrocyte transfusion (ET) in premature infants.

Material and Methods: Very low birth weight (VLBW) infants with gestational age (GA) < 32 weeks and/or birth weight (BW) <1500 g and hospitalized in neonatal intensive care unit (NICU) between 2012-2018 were retrospectively evaluated. ET was performed according to Ohls 2007 and Turkish Neonatalogy Society Blood Products Transfusion Guidelines.

Results: 72 infants included in this study. Mean BW was 1325 g (680-2290 g), GA was 30 weeks (25-32), median postnatal age was 36.7±26.9 days (8-129), number of ET during hospitalization was 2±1.2 (1-6). There were no significant changes in mean heart rates (p=0.183) and median respiratory rates before and after ET (p=0.123). Weight gain (16 g/day-11 g/day) was statistically similar before and after ET (p=0.861). A significant decrease in apnea, non-invasive ventilation (NIV) and caffeine therapy requirements after ET was determined (p<0.001, p=0.016 and p=0.016). Serum lactate (2.9-1.5) levels were decreased by ET (p=0.017).

Conclusion: Premature infants should closely follow-up for anemia and related symptoms during NICU stay. ET may help to decrease frequency of apnea of prematurity, requirements of caffeine therapy and NIV. ET improves tissue oxygenation in VLBW infants with anemia. Decision of ET should be made according to severity of symptoms, and should be performed according to international, national or local transfusion guidelines.

Anahtar Kelimeler

Prematüre, Anemia, Erythrocyte transfusion

Prematüre anemisi olan çok düşük doğum ağırlıklı bebeklere eritrosit transfüzyonunun etkisi

Öz

Amaç: Bu çalışmada prematüre bebeklerde eritrosit transfüzyonunun (ET) klinik etkisinin araştırılması amaçlandı.

Gereç ve Yöntemler: 2012-2018 yılları arasında yenidoğan yoğun bakım ünitesinde (YYBÜ) takip edilen ve gestasyonel haftası (GH)< 32 hafta ve/veya doğum ağırlığı (DA) < 1500 g olan çok düşük doğum ağırlıklı (ÇDDA) bebekler retrospektif olarak değerlendirildi. ET, Ohls 2007 ve Türk Neonatoloji Derneği Kan Ürünleri Transfüzyon Rehberi’ne göre yapıldı.

Bulgular: 72 hasta çalışmaya dahil edildi. Ortalama DA 1325 g (680-2290 g), GH 30 hafta (25-32), ortanca postnatal yaş 36.7±26.9 gün (8-129), hastanede yatış sırasındaki ET sayısı 2±1.2 (1-6)’dı. ET öncesi ve sonrası ortalama kalp hızlarında (p=0.183) ve medyan solunum hızlarında (p=0.123) anlamlı bir değişiklik yoktu. Kilo alımı (16 g/gün-11 g/gün), ET’den önce ve sonra istatistiksel olarak benzerdi (p=0.861). ET sonrası apne, non-invaziv ventilasyon (NIV) ve kafein tedavisi gereksinimlerinde anlamlı azalma saptandı (p<0.001, p=0.016 ve p=0.016). Serum laktat (2.9-1.5) seviyeleri ET ile azaldı (p=0.017).

Sonuç: Prematüre bebekler, YYBÜ’de kaldıkları süre boyunca anemi ve ilgili semptomlar açısından yakın takip edilmelidir. ET prematüre apne sıklığını, kafein tedavisi ve NIV gereksinimlerini azaltmaya yardımcı olabilir. ET anemili ÇDDA bebeklerde doku oksijenasyonunu düzeltir. ET kararı semptomların şiddetine göre verilmeli ve uluslararası, ulusal veya yerel transfüzyon rehberlerine göre yapılmalıdır.

Anahtar Kelimeler

Anemi, Eritrosit Transfüzyonu, Prematüre

Kaynakça

• Dumitrescu MP, Tanaka DT, Spears TG, Daniel CJ, Kumar KR, Athavale K, et al. Patterns of phlebotomy blood loss and transfusions in extremely low birth weight infants. J Perinatol 2019;39:1670-5.
• Dik PHB, Galletti MF, Carrascal MP, Gregorio AD, Pratx LB, Saldano AG, et al. Impact of the volume of blood collected by phlebotomy on transfusion requirements in preterm infants with birth weight of less than 1500 g. A quasi-experimental study. Arch Argent Pediatr 2020;118:109-16.
• Bell EF. Red cell transfusion thresholds for preterm infants: finally some answers. Arch Dis Child Fetal Neonatal Ed 2022;107:126-30.
• Balasubramanian H, Malpani P, Sindhur M, Kabra NS, Ahmed J, Srinivasan L. Effect of umbilical cord blood sampling versus admission blood sampling on requirement of blood transfusion in extremely preterm infants: a randomized controlled trial. J Pediatr 2019;211:39-45
• Meyer MP, O’Connor KL, Meyer JH. Thresholds for blood transfusion in extremely preterm infants: a review of the latest evidence from two large clinical trials. Front Pediatr 2022;20;10:957585.
• Kirpalani H, Bell EF, Hintz SR, Tan S, Schmidt B, Chaudhary AS, et al. Higher or lower hemoglobin transfusion thresholds for preterm ınfants. N Engl J Med 2020;383:2639-51.
• Lopriore E. Updates in red blood cell and platelet transfusions in preterm neonates. Am J Perinatol 2019;36:37-40.
• Benavides A, Bell EF, Georgieff MK, Josephson CD, Stowell SR, Feldman HA, et al. Sex-specific cytokine responses and neurocognitive outcome after blood transfusions in preterm infant. Pediatr Res 2022;91:947-54.
• Aher SM, Ohlsson A. Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2020;2:CD004865.
• Ozcan B, Aydemir O, Isik UD, Bas AY, Demirel N. Severe anemia is associated with intestinal injury in preterm neonates. Am J Perinatol 2020;37:603-6.
• Lum TG, Sugar J, Yim R, Fertel S, Morales A, Poeltler D, et al. Two-year neurodevelopmental outcomes of preterm infants who received red blood cell transfusion. Blood Transfus 2022;20:180-7.
• Balasubramanian H, Atyalgade M, Garg B, Srinivasan L, Kabra NS, Khapekar S. Effects of blood sampling stewardship and erythropoietin administration in extremely low birth weight infants-a quality improvement non-controlled before-and-after retrospective study. Eur J Pediatr 2021;180:1617-26
• Goldstein GP, Rao A, Ling AY, Ding VY, Chang IJ, Chock VY. Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants. Transfusion 2020;60:466-72.
• Poppe JA, Essen T, Weteringen W, Willemsen SP, Reiss IKM, Simons SHP, et al. Cardiorespiratory monitoring of red blood cell transfusions in preterm infants. Eur J Pediatr 2022;181:489-500.
• Fontana C, Raffaeli G, Pesenti N, Boggini T, Cortesi V, Manzoni F, et al. Red blood cell transfusions in preterm newborns and neurodevelopmental outcomes at 2 and 5 years of age.Blood Transfus 2022;20:40-9.
• Kalteren WS, Verhagen EA, Mintzer JP, Bos AF, Kooi EMW. Anemia and red blood cell transfusions, cerebral oxygenation, brain injury and development, and neurodevelopmental outcome in preterm infants:a systematic review. Front Pediatr 2021;26;9:644462.
• Maheshwari A, Patel RM, Christensen RD. Anemia, red blood cell transfusions, and necrotizing enterocolitis. Semin Pediatr Surg 2018;27:47-51.
• Song J, Dong H, Xu F, Wang Y, Li W, Jue Z, et al. The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates. PLoS One 2021;16:e0254810.
• Lorch SA, Srinivasan L, Escobar GJ. Epidemiology of apnea and bradycardia resolution in premature infants. Pediatrics. 2011;128:e366-73.
• Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr. 1987;17:213-88.
• Papile LA, Munsick-Bruno G, Schaefer A. Relationship of cerebral intraventricular hemorrhage and childhood neurologic handicaps. J Pediatr. 1983;103:273-7.
• International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity of revisited. Arch Ophthalmol 2005;123:991-9.
• Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Care Med. 2001;163: 1723-9.
• Erdeve O, Yurttutan S, Altuğ N, Ozdemir R, Gokmen T, Dilmen U, et al. Oral versus intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2012;97:F279-83.
• Ohls RK. Transfusions in the preterm infant. NeoReviews. 2007;8:e377-88.
• Cetinkaya M, Atasoy B, Perk Y. Turkish neonatal society guideline on the transfusion principles in newborns. Turk Pediatri Ars 2018;53:101-8.
• Ohlsson A, Aher SM. Early erythropoiesis-stimulating agents in preterm or low birth weight infants. Cochrane Database Syst Rev 2020;2:CD004863.
• Saito-Benz MS, Flanagan P, Berry MJ. Management of anaemia in pre-term infants.Br J Haematol 2020;188:354-66.
• El-Lahony DM, Saleh NY, Habib MS, Shehata MA, El-Hawy MA. The role of recombinant Human erythropoietin in neonatal anemia. Hematol Oncol Stem Cell Ther 2020;13:147-51.
• Cibulskis CC, Maheshwari A, Rao A, Mathur MA. Anemia of prematurity: how low is too low? J Perinatol 2021;41:1244-57.
• Kasat K, Hendricks KD, Mally PV. Neonatal red blood cell transfusions: searching for better guidelines. Blood Transfus 2011;9:86-94.
• Priya RAS, Krishnamoorthy R, Panicker VK, Ninan B. Transfusion support in premature neonates <1500 g and/or <32 weeks in a tertiary care center: A descriptive study. Asian J Transfus Sci 2018;12:34-41.
• Lopriore E. Updates in red blood cell and platelet transfusions in preterm neonates. Am J Perinatol 2019;36:37-40.
• Meyer J, Sive A, Jacobs P. Empiric red cell transfusion in asymptomatic premature infants. Acta Paediatr 1993;82:30-4.
• Nelle M, Hocker C, Zilow EP, Linderkamp O. Effects of red cell transfusion on cardiac output and blood flow velocities in cerebral and gastrointestinal arteries in prematüre infants. Arch Dis Child Fetal Neonatal Ed 1994;71:45-8.
• Lachance C, Chessex P, Fouron JC, Widness JA, Bard H. Myocardial, erythropoietic and metabolic adaptations to anemia of prematurity. J Pediatr 1994;125:278-82.
• Dani C, Pezzati M, Martelli E, Prussi C, Bertini G, Rubaltelli FF. Effect of blood transfusions on cerebral haemodynamics in preterm infants. Acta Paediatr 2002;91:938-41.
• Alkalay AL, Galvis S, Ferry DA, Simmons CF, Krueger RC. Hemodynamic changes in anemic prematüre infants: are we allowing the hematocrits to fall too low? Pediatrics 2003;112:838-45.
• Mimica AF, Santos NMA, Cunha DH, Guinsburg R, Bordin JO, Chiba A, et al. A very strict guideline reduces the number of erythrocyte transfusions in premature infants. Vox Sang 2008;95:106-11.
• Santos NMA, Guinsburg R, Almeida MFB, Procianoy RS, Marba STM, Ferri WAG, et al. Factors associated with red blood cell transfusions in very low-birth-weight premature infants in brazilian neonatal units. BMC Pediatrics 2015;15:113.doi: 10.1186/s12887-015-0432-6.
• Kirpalani H, Whyte RK. What is new about transfusions for preterm infants? an update. Neonatology 2019;115:406-10.