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Randomized Controlled Trial
. 2023 Nov 1;6(11):e2341643.
doi: 10.1001/jamanetworkopen.2023.41643.

Differences in Cerebral Tissue Oxygenation in Preterm Neonates Receiving Adult or Cord Blood Red Blood Cell Transfusions

Claudio Pellegrino  1   2 , Patrizia Papacci  3   4 , Flavia Beccia  3   4 , Francesca Serrao  3 , Giulia Vanina Cantone  3 , Giorgio Cannetti  2 , Carmen Giannantonio  3 , Giovanni Vento  3   4 , Luciana Teofili  1   2
Affiliations
Randomized Controlled Trial

Differences in Cerebral Tissue Oxygenation in Preterm Neonates Receiving Adult or Cord Blood Red Blood Cell Transfusions

Claudio Pellegrino et al. JAMA Netw Open. .

Abstract

Importance: Repeated transfusions in preterm neonates with anemia of prematurity replace fetal hemoglobin (HbF) with adult Hb (HbA), which has a low oxygen affinity. The reduction of HbF is associated with a higher incidence of retinopathy of prematurity (ROP).

Objective: To assess whether HbF and HbA are differently associated with cerebral tissue oxygenation in preterm neonates.

Design, setting, and participants: This cohort study was a single-center, pilot study on cerebral oxygenation kinetics in preterm neonates with a gestational age between 24.0 weeks and 27.9 weeks who were admitted to the neonatal intensive care unit of Policlinico Universitario A. Gemelli IRCCS from December 27, 2021, to May 15, 2023. This study was ancillary to the ongoing, double-blind, multicenter Umbilical or Adult Donor Red Blood Cells in Extremely Low Gestational Age Neonates and Retinopathy of Prematurity (BORN) randomized clinical trial. The BORN trial outcome was ROP severity in neonates randomized to receive standard packed red blood cell (PRBC) transfusions obtained from RBCs of adult donors (A-RBCs) or from cord blood (CB-RBCs). According to standard procedures at the institute's neonatal intensive care unit, patients concurrently received continuous cerebral near-infrared spectroscopy (NIRS) monitoring. This cohort study was not prespecified in the trial protocol.

Exposure: Transfusion with A-RBCs or CB-RBCs.

Main outcomes and measures: The main outcome was the kinetics of cerebral regional oxygen saturation (crSO2) and cerebral fraction of tissue oxygen extraction (cFTOE) associated with A-RBC or CB-RBC transfusions. Cerebral NIRS monitoring was performed by neonatologists and nurses, who were blinded to the PRBC type. The NIRS monitoring was conducted starting with the blood product order, during transfusion, and for the subsequent 24 hours after transfusion completion. The mean treatment effects of A-RBCs or CB-RBCs were quantified using a linear mixed model for repeated measures.

Results: Of 23 randomized neonates, 17 (11 male [64.7%]; median gestational age at birth, 25.6 weeks [IQR, 25.3-26.1 weeks]) with a median birth weight of 840 g (IQR, 580-900 g) were included in the study; NIRS was evaluated for 42 transfusion episodes, of which 22 were A-RBCs and 20 were CB-RBCs. Globally considering all posttransfusion time points, the overall crSO2 covariate-adjusted mean after CB-RBC transfusions was 5.27% lower (95% CI, 1.20%-9.34%; P = .01) than that after A-RBC transfusions, while the cFTOE after CB-RBC transfusions was 6.18% higher (95% CI, 1.66%-10.69%; P = .009) than that after A-RBCs.

Conclusions and relevance: The findings of this cohort study suggest that A-RBC transfusions may be associated with more oxygen delivery to cerebral tissues of preterm neonates than transfusions from CB-RBCs. This finding may explain the previously observed association between low HbF and high ROP risk. It also suggests that use of CB to meet the RBC transfusion needs of neonates with a gestational age of less than 28 weeks may protect cerebral tissues from overexposure to oxygen.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Timeline of Near-Infrared Spectroscopy (NIRS) Monitoring and Flowchart of Study Population Selection
A-RBCs indicates adult red blood cells; CB, cord blood; crSO2, cerebral regional oxygen saturation; PRBC, packed RBC; PRBCT, PRBC transfusion; SpO2, peripheral arterial oxygen saturation; and T, time point.
Figure 2.
Figure 2.. Correlation Between Pretransfusion Fetal Hemoglobin (HbF) and Baseline Cerebral Regional Oxygen Saturation (crSO2) and Cerebral Fraction of Tissue Oxygen Extraction (FTOE) Values
Figure 3.
Figure 3.. Association of Adult Red Blood Cell (A-RBC) and Cord Blood RBC (CB-RBC) Transfusions With Cerebral Oxygenation Parameters in a Mixed Model for Repeated Measures Analysis
cFTOE indicates cerebral fraction of tissue oxygen extraction and crSO2, cerebral regional oxygen saturation.
See this image and copyright information in PMC

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