Article | Published:

Packed red blood cells transfusion in neonates: effect on FiO2 and PaO2/SaO2 ratio, and implications for neonatal saturation targeting

Journal of Perinatologyvolume 38pages693695 (2018) | Download Citation



To assess the effect of blood transfusions in neonates on partial pressure of oxygen in arterial blood (PaO2), arterial hemoglobin oxygen saturation (SaO2) and arterial hemoglobin oxygen saturation as measured by pulse oximetry (SpO2).

Study design

Retrospective study of neonates that received a first blood transfusion while having an indwelling arterial line. We compared PaO2, SaO2, SpO2, SaO2/PaO2 ratio and fraction of inspired oxygen (FiO2) 12 h before and after blood transfusion.


Post-transfusion neonates had higher PaO2 and SaO2, had lower SaO2/PaO2 ratio, and received higher FiO2 with no change in SpO2.


Post-transfusion, neonates had lower hemoglobin oxygen affinity. They received higher FiO2 and had higher PaO2 at the same SpO2. We speculate that FiO2 was increased in order to maintain SpO2. Larger prospective trials are needed to confirm our findings.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Phillips HM, Holland BM, Jones JG, Abdel-Moiz AL, Turner TL, Wardrop CA. Definitive estimate of rate of hemoglobin switching: measurement of percent hemoglobin F in neonatal reticulocytes. Pediatr Res. 1988;23:595–7.

  2. 2.

    De Halleux V, Gagnon C, Bard H. Decreasing oxygen saturation in very early preterm newborn infants after transfusion. Arch Dis Child Fetal Neonatal Ed. 2003;88:F163.

  3. 3.

    Askie LM, Darlow BA, Davis PG, Finer N, Stenson B, Vento M et al. Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants (Review). The Cochrane Collaboration 2017;4:CD011190.

  4. 4.

    Shiao SY. Effects of fetal hemoglobin on accurate measurements of oxygen saturation in neonates. J Perinat Neonatal Nurs. 2005;19:348–61.

  5. 5.

    James L, Greenough A, Naik S. The effect of blood transfusion on oxygenation in premature ventilated neonates. Eur J Pediatr. 1997;156:139–41.

  6. 6.

    Rashid N, Al-Sufayan F, Seshia MM, Baier RJ. Post transfusion lung injury in the neonatal population. J Perinatol. 2013;33:292–6.

  7. 7.

    Lakshminrusimha S, Manja V, Mathew B, Suresh GK. Oxygen targeting in preterm infants: a physiological interpretation. J Perinatol. 2015;35:8–15.

  8. 8.

    Shiao SY, Ou CN, Pierantoni H. The measurement of accurate fetal hemoglobin and related oxygen saturation by the hemoximeter. Clin Chim Acta. 2006;374:75–80.

  9. 9.

    Fang J Sorita A, Carey WA, Colby CE, Murad MH, Alahdab F Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis. Pediatrics 2016;137. pii: e20153387.

Download references

Author information


  1. Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel

    • Itamar Nitzan
    • , Cathy Hammerman
    • , Francis B. Mimouni
    •  & Alona Bin-Nun
  2. The Faculty of Medicine of the Hebrew University, Jerusalem, Israel

    • Cathy Hammerman
    •  & Alona Bin-Nun
  3. Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel

    • Francis B. Mimouni


  1. Search for Itamar Nitzan in:

  2. Search for Cathy Hammerman in:

  3. Search for Francis B. Mimouni in:

  4. Search for Alona Bin-Nun in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Itamar Nitzan.

About this article

Publication history