Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia

Katrina T. Ibonia; Henrietta S. Bada; Philip M. Westgate; Enrique Gomez-Pomar; Prasad Bhandary; Abhijit Patwardhan; Elie G. Abu Jawdeh

doi:10.1111/trf.14808

Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia

Katrina T. Ibonia, Henrietta S. Bada, Philip M. Westgate, Enrique Gomez-Pomar, Prasad Bhandary, Abhijit Patwardhan, Elie G. Abu Jawdeh

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

BACKGROUND: Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with an increase in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH. STUDY DESIGN AND METHODS: We prospectively enrolled infants less than 30 weeks' gestation age. PI and oxygen saturation (SpO ₂ ) were monitored with high-resolution pulse oximeters 24 hours before and after RBC transfusion. Data were analyzed at three postnatal periods: Epoch 1, first week of life (1 to 7 days of life); Epoch 2, 2 to 4 weeks of life (8 to 28 days of life); and Epoch 3, 4 to 8 weeks of life. RESULTS: A total of 118 transfusions were analyzed. IH measures significantly decreased after transfusion in Epochs 2 and 3. PI significantly increased after transfusion, but it did not correlate with the decrease in IH measures. Mechanical ventilation, fraction of inspired oxygen (FiO ₂ ), and IH measures influenced the effects on oxygenation. CONCLUSIONS: RBC transfusion improved IH after the first week of life. The benefit in IH did not correlate with PI increase after transfusion. Pretransfusion respiratory support and IH measures predicted the effect of transfusion on oxygenation.

Original language	English
Pages (from-to)	2538-2544
Number of pages	7
Journal	Transfusion
Volume	58
Issue number	11
DOIs	https://doi.org/10.1111/trf.14808
State	Published - Nov 2018

Bibliographical note

Funding Information:
The authors thank all the Neonatal Intensive Care Unit nurses, research nurses, and personnel, fellow physicians and attending neonatologists at University of Kentucky Children's Hospital who all have paved the way in making sure we had good data collection.

Funding Information:
ABBREVIATIONS: IH = intermittent hypoxemia; IH-SpO2 < 80 = PI = perfusion index; %time-SpO2 < 80 = overall percent time spent with SpO2 of less than 80% From the 1Division of Neonatology, Department of Pediatrics; 2Department of Biostatistics, College of Public Health; and 3Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, Kentucky. Address reprint requests to: Elie G. Abu Jawdeh, Division of Neonatology, Department of Pediatrics, University of Kentucky; 138 Leader Avenue, Lexington, KY 40508; e-mail: ktibonia@gmail.com. This project described was supported by the National Center for Research Resources, UL1RR033173, and is now at the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH and The Gerber Foundation. Received for publication September 1, 2018; revision received February 28, 2018; and accepted March 25, 2018. doi:10.1111/trf.14808 © 2018 AABB TRANSFUSION 2018;58;2538–2544

Publisher Copyright:
© 2018 AABB

ASJC Scopus subject areas

Immunology and Allergy
Immunology
Hematology

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10.1111/trf.14808

Cite this

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title = "Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia",

abstract = " BACKGROUND: Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with an increase in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH. STUDY DESIGN AND METHODS: We prospectively enrolled infants less than 30 weeks' gestation age. PI and oxygen saturation (SpO 2 ) were monitored with high-resolution pulse oximeters 24 hours before and after RBC transfusion. Data were analyzed at three postnatal periods: Epoch 1, first week of life (1 to 7 days of life); Epoch 2, 2 to 4 weeks of life (8 to 28 days of life); and Epoch 3, 4 to 8 weeks of life. RESULTS: A total of 118 transfusions were analyzed. IH measures significantly decreased after transfusion in Epochs 2 and 3. PI significantly increased after transfusion, but it did not correlate with the decrease in IH measures. Mechanical ventilation, fraction of inspired oxygen (FiO 2 ), and IH measures influenced the effects on oxygenation. CONCLUSIONS: RBC transfusion improved IH after the first week of life. The benefit in IH did not correlate with PI increase after transfusion. Pretransfusion respiratory support and IH measures predicted the effect of transfusion on oxygenation.",

author = "Ibonia, {Katrina T.} and Bada, {Henrietta S.} and Westgate, {Philip M.} and Enrique Gomez-Pomar and Prasad Bhandary and Abhijit Patwardhan and {Abu Jawdeh}, {Elie G.}",

note = "Funding Information: The authors thank all the Neonatal Intensive Care Unit nurses, research nurses, and personnel, fellow physicians and attending neonatologists at University of Kentucky Children's Hospital who all have paved the way in making sure we had good data collection. Funding Information: ABBREVIATIONS: IH = intermittent hypoxemia; IH-SpO2 < 80 = PI = perfusion index; %time-SpO2 < 80 = overall percent time spent with SpO2 of less than 80% From the 1Division of Neonatology, Department of Pediatrics; 2Department of Biostatistics, College of Public Health; and 3Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, Kentucky. Address reprint requests to: Elie G. Abu Jawdeh, Division of Neonatology, Department of Pediatrics, University of Kentucky; 138 Leader Avenue, Lexington, KY 40508; e-mail: ktibonia@gmail.com. This project described was supported by the National Center for Research Resources, UL1RR033173, and is now at the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH and The Gerber Foundation. Received for publication September 1, 2018; revision received February 28, 2018; and accepted March 25, 2018. doi:10.1111/trf.14808 {\textcopyright} 2018 AABB TRANSFUSION 2018;58;2538–2544 Publisher Copyright: {\textcopyright} 2018 AABB",

year = "2018",

month = nov,

doi = "10.1111/trf.14808",

language = "English",

volume = "58",

pages = "2538--2544",

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TY - JOUR

T1 - Blood transfusions in preterm infants

T2 - changes on perfusion index and intermittent hypoxemia

AU - Ibonia, Katrina T.

AU - Bada, Henrietta S.

AU - Westgate, Philip M.

AU - Gomez-Pomar, Enrique

AU - Bhandary, Prasad

AU - Patwardhan, Abhijit

AU - Abu Jawdeh, Elie G.

N1 - Funding Information: The authors thank all the Neonatal Intensive Care Unit nurses, research nurses, and personnel, fellow physicians and attending neonatologists at University of Kentucky Children's Hospital who all have paved the way in making sure we had good data collection. Funding Information: ABBREVIATIONS: IH = intermittent hypoxemia; IH-SpO2 < 80 = PI = perfusion index; %time-SpO2 < 80 = overall percent time spent with SpO2 of less than 80% From the 1Division of Neonatology, Department of Pediatrics; 2Department of Biostatistics, College of Public Health; and 3Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, Kentucky. Address reprint requests to: Elie G. Abu Jawdeh, Division of Neonatology, Department of Pediatrics, University of Kentucky; 138 Leader Avenue, Lexington, KY 40508; e-mail: ktibonia@gmail.com. This project described was supported by the National Center for Research Resources, UL1RR033173, and is now at the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH and The Gerber Foundation. Received for publication September 1, 2018; revision received February 28, 2018; and accepted March 25, 2018. doi:10.1111/trf.14808 © 2018 AABB TRANSFUSION 2018;58;2538–2544 Publisher Copyright: © 2018 AABB

PY - 2018/11

Y1 - 2018/11

N2 - BACKGROUND: Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with an increase in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH. STUDY DESIGN AND METHODS: We prospectively enrolled infants less than 30 weeks' gestation age. PI and oxygen saturation (SpO 2 ) were monitored with high-resolution pulse oximeters 24 hours before and after RBC transfusion. Data were analyzed at three postnatal periods: Epoch 1, first week of life (1 to 7 days of life); Epoch 2, 2 to 4 weeks of life (8 to 28 days of life); and Epoch 3, 4 to 8 weeks of life. RESULTS: A total of 118 transfusions were analyzed. IH measures significantly decreased after transfusion in Epochs 2 and 3. PI significantly increased after transfusion, but it did not correlate with the decrease in IH measures. Mechanical ventilation, fraction of inspired oxygen (FiO 2 ), and IH measures influenced the effects on oxygenation. CONCLUSIONS: RBC transfusion improved IH after the first week of life. The benefit in IH did not correlate with PI increase after transfusion. Pretransfusion respiratory support and IH measures predicted the effect of transfusion on oxygenation.

AB - BACKGROUND: Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with an increase in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH. STUDY DESIGN AND METHODS: We prospectively enrolled infants less than 30 weeks' gestation age. PI and oxygen saturation (SpO 2 ) were monitored with high-resolution pulse oximeters 24 hours before and after RBC transfusion. Data were analyzed at three postnatal periods: Epoch 1, first week of life (1 to 7 days of life); Epoch 2, 2 to 4 weeks of life (8 to 28 days of life); and Epoch 3, 4 to 8 weeks of life. RESULTS: A total of 118 transfusions were analyzed. IH measures significantly decreased after transfusion in Epochs 2 and 3. PI significantly increased after transfusion, but it did not correlate with the decrease in IH measures. Mechanical ventilation, fraction of inspired oxygen (FiO 2 ), and IH measures influenced the effects on oxygenation. CONCLUSIONS: RBC transfusion improved IH after the first week of life. The benefit in IH did not correlate with PI increase after transfusion. Pretransfusion respiratory support and IH measures predicted the effect of transfusion on oxygenation.

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Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia

Abstract

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