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Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised?

Journal of Perinatology volume 38, pages 1022–1029 (2018)Cite this article

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Abstract

Objective

To determine the impact of progressive anemia of prematurity on cerebral regional saturation (C-rSO2) in preterm infants and identify the hemoglobin threshold below which a critical decrease (>2SD below the mean) in C-rSO2 occurs.

Study design

In a cohort of infants born ≤30 weeks EGA, weekly C-rSO2 data were prospectively collected from the second week of life through 36 weeks post-menstrual age (PMA). Clinically obtained hemoglobin values were noted at the time of recording. Recordings were excluded if they were of insufficient duration (<1 h) or if the hemoglobin was not measured within 7 days. Statistical analysis was performed using a linear mixed effects-model and ROC analysis. ROC analysis was used to determine the threshold of anemia, where C-rSO2 critically decreased >2SD below the mean normative value (<55%) in preterm infants.

Results

In total 253 recordings from 68 infants (mean EGA 26.9 ± 2.1 weeks, BW 1025 ± 287 g, 49% male) were included. Approximately 29 out of 68 infants (43%) were transfused during hospitalization. Mixed-model statistical analysis adjusting for EGA, BW, and PMA revealed a significant association between decreasing hemoglobin and C-rSO2 (p < 0.01) in transfusion-naive infants but not in transfused infants. In the transfusion naive group, using ROC analysis demonstrated a threshold hemoglobin of 9.5 g/dL (AUC 0.81, p < 0.01) for critical cerebral desaturation in preterm infants.

Conclusions

In transfusion-naive preterm infants, worsening anemia was associated with a progressive decrease in cerebral saturations. Analysis identified a threshold hemoglobin of 9.5 g/dL below which C-rSO2 dropped >2SD below the mean.

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Acknowledgements

We like to thank our study coordinator, Anthony Barton, and our research assistant, Laura Atwood, for their tireless efforts. We also thank all the patients and families who participated in this study.

Funding

This work was supported by the following grants: Washington University Institute of Clinical and Translational Sciences KL2 Training Program (NIH/NCATS KL2 TR000450); The Gerber Foundation; The Barnes-Jewish Hospital Foundation and the Washington University Institute of Clinical and Translational Sciences Clinical and Translational Funding Program (NIH/NCATS UL1 TR000448); NIH award R01HL124078.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Halana V. Whitehead, Zachary A. Vesoulis, Rakesh Rao & Amit M. Mathur

  2. Department of Pediatrics, Division of Neonatology, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Akhil Maheshwari

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Correspondence to Amit M. Mathur.

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Whitehead, H.V., Vesoulis, Z.A., Maheshwari, A. et al. Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised?. J Perinatol 38, 1022–1029 (2018). https://doi.org/10.1038/s41372-018-0120-0

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