ABSTRACT
Packed red blood cell transfusion may increase the risk of necrotizing enterocolitis
in premature infants. We hypothesize that the postprandial increase in mesenteric
blood flow velocity (MBFV) would not be altered by a blood transfusion in premature
infants. Infants born at 25 to 32 weeks and feeding at least 60 mL/kg/d who required
a transfusion were randomized within each of two weight strata to feed or not feed
during the transfusion. Mean, peak systolic, and end diastolic Doppler MBFV was measured
30 minutes before and after feedings at baseline (anemic) and with the first feeding
posttransfusion. Twenty-two infants (27.3 ± 2.3 weeks' gestational age; hemoglobin
[HgB] 9.3 ± 1.3 g/dL) were studied on day of life 3 to 71 (mean 31.2 days) and a corrected
gestational age of 31.8 ± 2.9 weeks. In the entire cohort, the peak systolic (p = 0.02) and the mean (p = 0.01) MBFV increased in response to feeding in the anemic but not the transfused
state. On subgroup analysis, only anemic infants > 1250 g (n = 12, HgB 8.6 ± 0.9 g/dL) had an increase in peak systolic (p = 0.04) and mean (p = 0.006) MBFV with feeding. In conclusion, the MBFV increases in response to feeding
in anemic preterm infants > 1250 g. We speculate that the lack of response to feeding
in the immediate posttransfusion state may contribute to the development of transfusion-associated
necrotizing enterocolitis.
KEYWORDS
Premature infant - anemia - mesenteric blood flow velocity - blood transfusion
REFERENCES
- 1
Lin P W, Stoll B J.
Necrotising enterocolitis.
Lancet.
2006;
368
1271-1283
- 2
Mally P, Golombek S G, Mishra R et al..
Association of necrotizing enterocolitis with elective packed red blood cell transfusions
in stable, growing, premature neonates.
Am J Perinatol.
2006;
23
451-458
- 3
Martinussen M, Brubakk A, Torstein V, Yao A.
Mesenteric blood flow velocity and its relation to transitional circulatory adaptation
in appropriate for gestational age preterm infants.
Pediatr Res.
1996;
39
275-280
- 4
Van Bel F, Van Zwieten P, Guit G, Schipper J.
Superior mesenteric artery blood flow velocity and estimated volume feed: duplex Doppler
US study of preterm and term neonates.
Radiology.
1990;
174
165-169
- 5
Bell M J.
Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.
Ann Surg.
1978;
187
1-7
- 6
Maruyama K, Koizumi T.
Superior mesenteric artery blood flow velocity in small for gestational age infants
of very low birth weight during the early neonatal period.
J Perinat Med.
2001;
29
64-70
- 7
Coombs R C, Morgan M, Durbin I, Booth W, McNeish A.
Abnormal gut flow velocities in neonates at risk of necrotising enterocolitis.
J Pediatr Gastroenterol Nutr.
1992;
15
13-19
- 8
Freeman-Ladd M, Cohen J, Carver J, Huhta J.
The hemodynamic effects of neonatal patent ductus arteriosus shunting on superior
mesenteric artery blood flow.
J Perinatol.
2005;
25
459-462
- 9
Christmann V, Liem K D, Semmekrot B A, van de Bor M.
Changes in cerebral, renal, and mesenteric blood flow velocity during continuous and
bolus infusion of indomethacin.
Acta Paediatr.
2002;
91
440-446
- 10
Leidig E.
Doppler analysis of superior mesenteric artery blood flow in preterm infants.
Arch Dis Child.
1989;
64
476-480
- 11 Polin R, Fox W, Abman S. Fetal and Neonatal Physiology. Philadelphia; Saunders
2004: 701-704
- 12
Nowicki P T.
Ischemia and necrotizing enterocolitis: where, when, and how.
Semin Pediatr Surg.
2005;
14
152-158
- 13
Reber K M, Nankervis C, Nowicki P T.
Newborn intestinal circulation physiology and pathophysiology.
Clin Perinatol.
2002;
29
23-39
- 14
Nowicki P T.
Postnatal changes in gut hemodynamics: a possible role for substance P.
Am J Physiol.
1998;
274
G1142-G1150
- 15
Reynolds J D, Ahearn G, Angelos M, Zhang J, Cobb F, Stamler J.
S-nitrosohemoglobin deficiency: a mechanism for loss of physiological activity in
banked blood.
Proc Natl Acad Sci U S A.
2007;
104
17058-17062
- 16
Kempley S T, Gamsu H R.
Superior mesenteric artery blood flow velocity in necrotising enterocolitis.
Arch Dis Child.
1992;
67
793-796
- 17
Hoecker C, Nelle M, Poeschl J, Beedgen B, Linderkamp O.
Caffeine impairs cerebral and intestinal blood flow velocity in preterm infants.
Pediatrics.
2002;
109
784-787
- 18
Gladman G, Sims D, Chiswick M.
Gastrointestinal blood flow velocity after the first feed.
Arch Dis Child.
1991;
66
17-20
- 19
Papile L A, Burstein J, Burstein R, Koffler H.
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of
infants with birth weights less than 1,500 gm.
J Pediatr.
1978;
92
529-534
Gretchen A KrimmelD.O.
Clinical Professor of Pediatrics, Division of Newborn Medicine
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
eMail: krimmelga@upmc.edu