Red blood cell transfusion-related necrotizing enterocolitis in very-low-birthweight infants: A near-infrared spectroscopy investigation

Teresa Mock Marin, James Moore, Niki Kosmetatos, John D. Roback, Paul Weiss, Melinda Higgins, Linda McCauley, Ora L. Strickland, Cassandra D. Josephson

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background Recent evidence suggests that antecedent red blood cell (RBC) transfusions increase the risk for necrotizing enterocolitis (NEC), the most common gastrointestinal emergency encountered by very-low-birthweight (VLBW) infants. The underlying mechanism for this association is unknown. Altered oxygenation of the mesenteric vasculature during RBC transfusion has been hypothesized to contribute to NEC development and was investigated in this study. Study Design and Methods Oxygenation patterns among four VLBW infants who developed transfusion-related NEC (TR-NEC) were compared to four VLBW infants with similar gestational age who were transfused but did not develop NEC (non-NEC). Cerebral and mesenteric patterns were recorded before, during, and 48 hours after RBC transfusion using near-infrared spectroscopy (NIRS) technology. Percentage change from mean baseline regional oxygen saturation values and cerebrosplanchnic oxygenation ratios were analyzed. Results All TR-NEC infants (24-29 weeks' gestation; 705-1080 g) demonstrated greater variation in mesenteric oxygenation patterns surrounding transfusions than non-NEC infants (27.6-30 weeks' gestation; 980-1210 g). TR-NEC infants received larger mean volumes of total blood (27.75 ± 8.77 mL/kg) than non-NEC infants (15.25 ± 0.5 mL/kg). Conclusion Wide fluctuation and decreases in mesenteric oxygenation patterns are more pronounced in TR-NEC infants, especially before TR-NEC onset, compared to non-NEC infants. Greater total volume of infused blood was associated with TR-NEC in preterm infants. Using NIRS, larger prospective studies are needed to further evaluate potential risk factors for NEC in this high-risk population.

Original languageEnglish (US)
Pages (from-to)2650-2658
Number of pages9
JournalTransfusion
Volume53
Issue number11
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

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Erythrocyte Transfusion
Necrotizing Enterocolitis
Near-Infrared Spectroscopy
Enterocolitis
Blood Volume
Pregnancy
Premature Infants
Gestational Age
Emergencies
Prospective Studies
Oxygen
Technology

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Red blood cell transfusion-related necrotizing enterocolitis in very-low-birthweight infants : A near-infrared spectroscopy investigation. / Marin, Teresa Mock; Moore, James; Kosmetatos, Niki; Roback, John D.; Weiss, Paul; Higgins, Melinda; McCauley, Linda; Strickland, Ora L.; Josephson, Cassandra D.

In: Transfusion, Vol. 53, No. 11, 01.11.2013, p. 2650-2658.

Research output: Contribution to journalArticle

Marin, TM, Moore, J, Kosmetatos, N, Roback, JD, Weiss, P, Higgins, M, McCauley, L, Strickland, OL & Josephson, CD 2013, 'Red blood cell transfusion-related necrotizing enterocolitis in very-low-birthweight infants: A near-infrared spectroscopy investigation', Transfusion, vol. 53, no. 11, pp. 2650-2658. https://doi.org/10.1111/trf.12158
Marin, Teresa Mock ; Moore, James ; Kosmetatos, Niki ; Roback, John D. ; Weiss, Paul ; Higgins, Melinda ; McCauley, Linda ; Strickland, Ora L. ; Josephson, Cassandra D. / Red blood cell transfusion-related necrotizing enterocolitis in very-low-birthweight infants : A near-infrared spectroscopy investigation. In: Transfusion. 2013 ; Vol. 53, No. 11. pp. 2650-2658.
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abstract = "Background Recent evidence suggests that antecedent red blood cell (RBC) transfusions increase the risk for necrotizing enterocolitis (NEC), the most common gastrointestinal emergency encountered by very-low-birthweight (VLBW) infants. The underlying mechanism for this association is unknown. Altered oxygenation of the mesenteric vasculature during RBC transfusion has been hypothesized to contribute to NEC development and was investigated in this study. Study Design and Methods Oxygenation patterns among four VLBW infants who developed transfusion-related NEC (TR-NEC) were compared to four VLBW infants with similar gestational age who were transfused but did not develop NEC (non-NEC). Cerebral and mesenteric patterns were recorded before, during, and 48 hours after RBC transfusion using near-infrared spectroscopy (NIRS) technology. Percentage change from mean baseline regional oxygen saturation values and cerebrosplanchnic oxygenation ratios were analyzed. Results All TR-NEC infants (24-29 weeks' gestation; 705-1080 g) demonstrated greater variation in mesenteric oxygenation patterns surrounding transfusions than non-NEC infants (27.6-30 weeks' gestation; 980-1210 g). TR-NEC infants received larger mean volumes of total blood (27.75 ± 8.77 mL/kg) than non-NEC infants (15.25 ± 0.5 mL/kg). Conclusion Wide fluctuation and decreases in mesenteric oxygenation patterns are more pronounced in TR-NEC infants, especially before TR-NEC onset, compared to non-NEC infants. Greater total volume of infused blood was associated with TR-NEC in preterm infants. Using NIRS, larger prospective studies are needed to further evaluate potential risk factors for NEC in this high-risk population.",
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T1 - Red blood cell transfusion-related necrotizing enterocolitis in very-low-birthweight infants

T2 - A near-infrared spectroscopy investigation

AU - Marin, Teresa Mock

AU - Moore, James

AU - Kosmetatos, Niki

AU - Roback, John D.

AU - Weiss, Paul

AU - Higgins, Melinda

AU - McCauley, Linda

AU - Strickland, Ora L.

AU - Josephson, Cassandra D.

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N2 - Background Recent evidence suggests that antecedent red blood cell (RBC) transfusions increase the risk for necrotizing enterocolitis (NEC), the most common gastrointestinal emergency encountered by very-low-birthweight (VLBW) infants. The underlying mechanism for this association is unknown. Altered oxygenation of the mesenteric vasculature during RBC transfusion has been hypothesized to contribute to NEC development and was investigated in this study. Study Design and Methods Oxygenation patterns among four VLBW infants who developed transfusion-related NEC (TR-NEC) were compared to four VLBW infants with similar gestational age who were transfused but did not develop NEC (non-NEC). Cerebral and mesenteric patterns were recorded before, during, and 48 hours after RBC transfusion using near-infrared spectroscopy (NIRS) technology. Percentage change from mean baseline regional oxygen saturation values and cerebrosplanchnic oxygenation ratios were analyzed. Results All TR-NEC infants (24-29 weeks' gestation; 705-1080 g) demonstrated greater variation in mesenteric oxygenation patterns surrounding transfusions than non-NEC infants (27.6-30 weeks' gestation; 980-1210 g). TR-NEC infants received larger mean volumes of total blood (27.75 ± 8.77 mL/kg) than non-NEC infants (15.25 ± 0.5 mL/kg). Conclusion Wide fluctuation and decreases in mesenteric oxygenation patterns are more pronounced in TR-NEC infants, especially before TR-NEC onset, compared to non-NEC infants. Greater total volume of infused blood was associated with TR-NEC in preterm infants. Using NIRS, larger prospective studies are needed to further evaluate potential risk factors for NEC in this high-risk population.

AB - Background Recent evidence suggests that antecedent red blood cell (RBC) transfusions increase the risk for necrotizing enterocolitis (NEC), the most common gastrointestinal emergency encountered by very-low-birthweight (VLBW) infants. The underlying mechanism for this association is unknown. Altered oxygenation of the mesenteric vasculature during RBC transfusion has been hypothesized to contribute to NEC development and was investigated in this study. Study Design and Methods Oxygenation patterns among four VLBW infants who developed transfusion-related NEC (TR-NEC) were compared to four VLBW infants with similar gestational age who were transfused but did not develop NEC (non-NEC). Cerebral and mesenteric patterns were recorded before, during, and 48 hours after RBC transfusion using near-infrared spectroscopy (NIRS) technology. Percentage change from mean baseline regional oxygen saturation values and cerebrosplanchnic oxygenation ratios were analyzed. Results All TR-NEC infants (24-29 weeks' gestation; 705-1080 g) demonstrated greater variation in mesenteric oxygenation patterns surrounding transfusions than non-NEC infants (27.6-30 weeks' gestation; 980-1210 g). TR-NEC infants received larger mean volumes of total blood (27.75 ± 8.77 mL/kg) than non-NEC infants (15.25 ± 0.5 mL/kg). Conclusion Wide fluctuation and decreases in mesenteric oxygenation patterns are more pronounced in TR-NEC infants, especially before TR-NEC onset, compared to non-NEC infants. Greater total volume of infused blood was associated with TR-NEC in preterm infants. Using NIRS, larger prospective studies are needed to further evaluate potential risk factors for NEC in this high-risk population.

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