Mesenteric Perfusion Pattern Changes as the Result of Packed Red Blood Cell Transfusions in Preterm Infants

Necrotizing enterocolitis is the most serious gastrointestinal emergency encountered by very low birth weight (VLBW) infants. Approximately half of the 4500 preterm infants affected annually require surgical intervention, with associated mortality rates of 30%-50%. Extensive research has determined that NEC pathogenesis is most likely multifactorial; however, prematurity is the only definitive predictor. Clear predictive and prevention strategies for this disease remain unknown and its incidence unchanged.;Recent evidence demonstrates a temporal relationship between packed red blood cell (PRBC) administration and NEC development. Although the underlying pathophysiology of this occurrence is unknown, leading theories suggest gastrointestinal immaturity and the age of blood infused may substantially increase the risk for transfusion-related NEC. Therefore, perfusion alterations as a result of changing blood flow subsequent to transfusion and the age of blood administered may increase the risk for ischemic insult.;This observational, prospective study endeavored to identify changes in mesenteric tissue perfusion by monitoring differential tissue oxygenation using near-infrared spectroscopy in preterm infants receiving blood transfusions. In addition, the relationship between the age of blood infused and perfusion pattern alteration was observed.;Thirty-three transfusion events were observed. It was concluded that the most immature infants demonstrated lower mesenteric perfusion following PRBC administration. The administration of PRBCs greater than six days old was also associated with decreased mesenteric perfusion. Four infants developed NEC temporally associated with PRBC transfusions, occurring within 48 hours of blood infusion. Infants who developed transfusion-related NEC were gestationally younger, more likely to have received enteral feedings during the transfusion, received larger volumes of feedings and received greater volumes of blood than infants who did not develop transfusion-related NEC.