The following is a summary of “Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants: A Secondary Near-Infrared Spectroscopy Study of the Transfusion of Prematures Randomized Clinical Trial (TOP NIRS),” published in the September 2023 issue of Pediatrics by Chock et al. 

In a secondary analysis of the TOP multicenter trial involving preterm infants, researchers studied the impact of red blood cell transfusions on tissue oxygen saturation. The study, conducted at 16 neonatal units, observed infants with gestational ages of 22 to 28 weeks and birth weights under 1000 grams. 

They investigated how transfusions affected cerebral and mesenteric tissue saturation and oxygen extraction levels in varying degrees of anemia. Additionally, it explored the link between cerebral saturation and adverse outcomes like death or neurodevelopmental impairment in infants aged 22 to 26 months. This analysis spanned October 2020 to May 2022.

Involving 179 infants with a mean gestational age of 25.9 weeks, researchers observed 237 transfusion events among 101 infants. The study revealed that transfusions led to a notable increase in cerebral (Csat) and mesenteric (Msat) tissue saturations, with Csat rising by 4.8% (in the lower hemoglobin threshold group) and 2.7% (in the higher threshold group) and Msat increasing by 6.7% and 5.6%, respectively. Cerebral and mesenteric fractional tissue oxygen extraction levels decreased similarly in both groups. The occurrence of neurodevelopmental impairment or death in 36 infants (37%) was associated with a higher pretransfusion Csat below 50% (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03).

Researchers found increased Csat and Msat after transfusion without SpO₂ changes, suggesting potential risk with lower pretransfusion Csat, prompting the need for focused tissue saturation monitoring in anemic preterm infants.

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2809782