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Red cell infusion but not saline is effective for volume expansion in preterm piglets

Pediatric Research volume 94, pages 112–118 (2023)Cite this article

Abstract

Background

A common first-line treatment for supporting cardiovascular function in preterm infants is volume expansion using saline, but this does not improve outcomes. This study aimed to determine if volume expansion with saline increases blood volume, blood pressure and cerebral oxygenation; and if volume expansion with packed red blood cells (RBC) is more effective. We hypothesized that RBC infusion is more effective than saline for increasing blood volume and maintaining cardiovascular function and cerebral oxygenation.

Methods

Five groups of preterm piglets (98/115d gestation) were infused with saline (10 or 20 mL/kg) or RBC (10 or 20 mL/kg) or no treatment. Blood volume, blood pressure, central venous pressure, heart rate, carotid flow, cerebral oxygenation, arterial pH, base excess, and lactate levels were assessed for 6 h after treatment started.

Results

Both RBC groups had significant increases in blood volume, and improved measures of cardiovascular function, cerebral oxygenation and metabolic acidosis. Saline infusion did not increase blood volume or measures of cardiovascular function, cerebral oxygenation or metabolic acidosis.

Conclusions

The results suggest that the deteriorating cardiovascular function in the hours after birth in preterm piglets, and possibly in premature babies, may be reversed or halted by more effective support of blood volume.

Impact

  • Blood volume decreases after birth in preterm piglets and this decrease is associated with deteriorating cardiovascular function and cerebral oxygenation.

  • Infusion of saline does not increase blood volume nor prevent deterioration in cardiovascular function.

  • Infusion of packed red blood cells results in an increase in blood volume and improvements in cardiovascular function and cerebral oxygenation.

  • Deteriorating cardiovascular function in the hours after birth in preterm piglets, and possibly in human preterm neonates, may be reversed or halted by more effective support of blood volume.

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Fig. 1: Blood volume in preterm piglets.
Fig. 2: Blood pressures and heart rate in preterm piglets.
Fig. 3: Brain oxygenation in preterm piglets.
Fig. 4: Lactate levels in preterm piglets.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to express their appreciation to Dr Elliot Teo for his assistance with preparation of the manuscript.

Funding

This study was funded by the National Health and Medical Research Council of Australia (APP1127142).

Author information

Authors and Affiliations

  1. Perinatal Research Centre and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Yvonne A. Eiby, Ian M. R. Wright & Barbara E. Lingwood

  2. Australian Institute of Tropical Health and Medicine and The College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia

    Ian M. R. Wright

  3. Department of Neonatal Medicine, Women’s and Children’s Hospital Adelaide, Adelaide, SA, Australia

    Michael J. Stark

  4. Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Michael J. Stark

  5. Department of Neonatology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Barbara E. Lingwood

Authors
  1. Yvonne A. Eiby
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  2. Ian M. R. Wright
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  3. Michael J. Stark
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  4. Barbara E. Lingwood
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Contributions

Y.E., I.W., M.S. and B.L. conceptualized and designed the study. Y.E., I.W. and B.L. collected, analyzed and interpreted the data. Y.E. drafted the initial manuscript. All authors reviewed and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yvonne A. Eiby.

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Eiby, Y.A., Wright, I.M.R., Stark, M.J. et al. Red cell infusion but not saline is effective for volume expansion in preterm piglets. Pediatr Res 94, 112–118 (2023). https://doi.org/10.1038/s41390-022-02403-2

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