The short-term effects of RBC transfusions on intestinal injury in preterm infants

Willemien S Kalteren; Arend F Bos; Klasien A Bergman; Willem van Oeveren; Jan B F Hulscher; Elisabeth M W Kooi

doi:10.1038/s41390-022-01961-9

The short-term effects of RBC transfusions on intestinal injury in preterm infants

Pediatr Res. 2023 Apr;93(5):1307-1313. doi: 10.1038/s41390-022-01961-9. Epub 2022 Feb 4.

Authors

Willemien S Kalteren¹, Arend F Bos², Klasien A Bergman², Willem van Oeveren³, Jan B F Hulscher⁴, Elisabeth M W Kooi²

Affiliations

¹ Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. w.s.kalteren@umcg.nl.
² Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ HaemoScan BV, Groningen, The Netherlands.
⁴ Division of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Abstract

Background: Anemic preterm infants may require red blood cell (RBC) transfusions to maintain sufficient oxygen supply to vital organs. Transfusion treatment, however, may have adverse intestinal effects. We aimed to investigate the short-term effects of RBC transfusions, hypothesizing to find signs of oxidative stress and intestinal injury, possibly related to levels of splanchnic (re-)oxygenation.

Methods: We prospectively included preterm infants (gestational age < 32 weeks). We measured urinary biomarkers for oxidative stress (8-isoprostane) and intestinal cell injury (intestinal fatty acid-binding protein, I-FABP) shortly before and after RBC transfusion. Splanchnic oxygen saturation (r_sSO₂) and r_sSO₂ variability were assessed simultaneously.

Results: Twenty-nine preterm infants received 58 RBC transfusions at various postnatal ages. Six of them developed necrotizing enterocolitis (NEC) after transfusion. Urinary 8-isoprostane and I-FABP increased following RBC transfusion (median 282-606 pg/ml and 4732-6968 pg/ml, p < 0.01), more pronounced in infants who developed NEC. Change in I-FABP correlated with change in 8-isoprostane (rho = 0.623, p < 0.01). Lower r_sSO₂ variability, but not higher mean r_sSO₂ was associated with higher 8-isoprostane and I-FABP levels after transfusion.

Conclusions: Preterm RBC transfusions are associated with concomitant signs of oxidative stress and intestinal injury, parallel with lower variability in splanchnic oxygenation. This may represent the early pathogenetic process of transfusion-associated NEC.

Impact: Red blood cell (RBC) transfusions in preterm infants are associated with a near 2-fold increase in urinary biomarkers for oxidative stress (8-isoprostane) and intestinal cell injury (intestinal fatty acid-binding protein, I-FABP). Magnitude of change in I-FABP strongly correlated with the magnitude of 8-isoprostane change, suggesting a role for oxidative stress in the pathogenesis of intestinal injury. Lower splanchnic oxygen saturation variability following RBC transfusion was associated with higher 8-isoprostane and I-FABP levels. Loss of splanchnic variability after RBC transfusion may result from increased oxidative stress and its concomitant intestinal injury, possibly representing the early pathogenetic process of transfusion-associated necrotizing enterocolitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Enterocolitis, Necrotizing* / etiology
Fatty Acid-Binding Proteins
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature
Intestinal Diseases* / therapy
Intestines

Substances

Fatty Acid-Binding Proteins