Splanchnic Oxygenation Response to Feeds in Preterm Neonates: Effect of Red Blood Cell Transfusion

Study Overview
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Brief Summary
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Since 1987, red blood cell (RBC) transfusions have been proposed as a potential risk factor for necrotizing enterocolitis (NEC), which is one of the most severe gastrointestinal complications of prematurity. Evidence from Doppler studies have shown a post-transfusion impairment of mesenteric blood flow in response to feeds, whereas NIRS studies have reported transient changes of splanchnic oxygenation after RBC transfusion; a possible role for these findings in increasing the risk for TANEC development has been hypothesized. The aim of this study is to evaluate SrSO2 patterns in response to enteral feeding before and after transfusion.

Detailed Description
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Premature neonates are among the most transfused population, but the risks and benefits of this procedure remain unclear. Since 1987, red blood cell (RBC) transfusions have been proposed as a potential risk factor for necrotizing enterocolitis (NEC), which is one of the most common and feared gastrointestinal complications of prematurity. Several observational studies have tried to demonstrate this causal correlation, defining the so-called transfusion-associated NEC (TANEC), which occurs within 48 hours after RBC transfusion. Evidence from Doppler studies have shown a post-transfusion impairment of mesenteric blood flow in response to feeds, whereas NIRS studies have reported transient changes of splanchnic oxygenation after RBC transfusion. This evidence, which has been hypothesized to play a role on the risk of TANEC development, has significantly raised the attention over the feeding plans during and after RBC transfusion. To date, splanchnic oxygenation response to feeds before and after transfusion has not been investigated, but could bring useful information to understand the splanchnic hemodynamic changes associated to RBC transfusion. Therefore, the aim of this study is to evaluate SrSO2 patterns in response to enteral feeding before and after transfusion. Enrolled infants will undergo a 12-h monitoring of cerebral (CrSO2) and splanchnic (SrSO2) oxygenation, performed using an INVOS 5100 oxymeter (Medtronic, Boulder, CO), whose neonatal sensors will be placed in the central region of the forehead and the below the umbilicus, respectively. The study monitoring includes the following phases: Phase 1 (0-3 hours): pre-transfusion feed and related post-prandial period Phase 2 (4-9 hours): RBC transfusion (10 ml/kg),administered over 3 hours, following which feeds are hold for 3 hours. Phase 3 (10-12 hours): post-transfusion feed and related post-prandial period. CrSO2 and SrSO2 patterns before and after transfusion and the related changes from baseline values will be analyzed. SCOR (CrSO2/SrSO2 ratio) patterns will be also calculated and analyzed. IBM SPSS Statistics (Statistical Package for the Social Sciences, SPSS Inc., IBM, Armonk, NY) will be used for statistical analysis. If any infant develops TANEC after transfusion, the related patterns will be evaluated and analyzed separately.

Official Title
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Splanchnic Oxygenation in Response to Enteral Feeds Before and After Red Blood Cell Transfusion in Preterm Infants

Conditions
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Blood Transfusion Complication, Necrotizing Enterocolitis, Enteral Feeding Intolerance, Preterm Infant

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: gestational age <32 weeks or birth weight <1500 g need for red blood cell transfusion according to national guidelines Exclusion Criteria: hemodynamic instability Prior occurrence of necrotizing or presence of symptoms and signs of feeding intolerance within one week before transfusion

Ages Eligible for Study
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Minimum Age: 1 Day
Maximum Age: 3 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Transfused infants<br>Preterm infants undergone red blood cell transfusion during hospital stay. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pre-transfusion splanchnic oxygenation pattern | Decrease or increase of splanchnic oxygenation during and after feed administration compared to pre-prandial baseline value | Enteral feed before red blood cell transfusion administration (3 hours) | 
| Post-transfusion splanchnic oxygenation pattern | Decrease or increase of splanchnic oxygenation during and after feed administration compared to pre-prandial baseline value | Enteral feed after red blood cell transfusion administration (3 hours) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of gut complications | Occurrence of necrotizing enterocolitis or feeding intolerance in infants undergone red blood cell transfusion | 48 hours after transfusion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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NIRS, TANEC, splanchnic oxygenation, enteral feeding, preterm infants