دورية أكاديمية
أعرض في EDS

Association of Bolus Feeding With Splanchnic and Cerebral Oxygen Utilization Efficiency Among Premature Infants With Anemia and After Blood Transfusion.

التفاصيل البيبلوغرافية
العنوان: Association of Bolus Feeding With Splanchnic and Cerebral Oxygen Utilization Efficiency Among Premature Infants With Anemia and After Blood Transfusion.
المؤلفون: Balegar V KK; Department of Neonatology, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Kingswood, Australia.; The Charles Perkins Center, The University of Sydney, Sydney, Australia., Jayawardhana M; School of Biomedical Engineering, The University of Sydney, Sydney, Australia.; The Charles Perkins Center, The University of Sydney, Sydney, Australia., Martin AJ; NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia., de Chazal P; School of Biomedical Engineering, The University of Sydney, Sydney, Australia.; The Charles Perkins Center, The University of Sydney, Sydney, Australia., Nanan RKH; The Charles Perkins Center, The University of Sydney, Sydney, Australia.
المصدر: JAMA network open [JAMA Netw Open] 2020 Feb 05; Vol. 3 (2), pp. e200149. Date of Electronic Publication: 2020 Feb 05.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Anemia, Neonatal/*therapy , Enteral Nutrition/*methods , Erythrocyte Transfusion/*adverse effects , Splanchnic Circulation/*physiology, Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Male ; Oxygen/metabolism ; Prospective Studies
مستخلص: Importance: The pathogenesis of transfusion-associated necrotizing enterocolitis remains elusive. Splanchnic hypoperfusion associated with packed red blood cell transfusion (PRBCT) and feeding has been implicated, but studies of splanchnic tissue oxygenation with respect to feeding plus PRBCT are lacking.
Objective: To investigate the oxygen utilization efficiency of preterm gut and brain challenged with bolus feeding during anemia and after transfusion using near-infrared spectroscopy.
Design, Setting, and Participants: This prospective cohort study conducted from September 1, 2014, to November 30, 2016, at a tertiary neonatal intensive care unit included 25 hemodynamically stable infants with gestational age less than 32 weeks, birth weight less than 1500 g, and postmenstrual age younger than 37 weeks. Data analysis was performed from August 1, 2017, to October 31, 2018.
Exposures: Infants received PRBCT (15 mL/kg for 4 hours) and at least 120 mL/kg daily of second hourly bolus feedings.
Main Outcomes and Measures: Splanchnic fractional tissue oxygen extraction (FTOEs) and cerebral fractional tissue oxygen extraction (FTOEc) measures were made during 75-minute feeding cycles that comprised a 15-minute preprandial feeding phase (FP0) and 4 contiguous 15-minute postprandial feeding phases (FP1, FP2, FP3, and FP4; each 15 minutes long). The intraindividual comparisons of feeding-related changes were evaluated during the pretransfusion epoch (TE0: 4 hours before onset of transfusion) and 3 TEs after transfusion (TE1: first 8 hours after PRBCT completion; TE2: 9-16 hours after PRBCT completion; and TE3: 17-24 hours after PRBCT completion).
Results: Of 25 enrolled infants (13 [52%] female; median birth weight, 949 g [interquartile range {IQR}, 780-1100 g]; median gestational age, 26.9 weeks [IQR, 25.9-28.6 weeks]; median enrollment weight, 1670 g [IQR, 1357-1937 g]; and median postmenstrual age, 34 weeks [IQR, 32.9-35 weeks]), 1 infant was excluded because of corrupted near-infrared spectroscopy data. No overall association was found between FTOEs and FPs in a multivariable repeated-measures model that accounted for transfusion epochs (primary analysis approach) (FP0: mean estimate, 11.64; 95% CI, 9.55-13.73; FP1: mean estimate, 12.02; 95% CI, 9.92-14.11; FP2: mean estimate, 12.77; 95% CI, 10.68-14.87; FP3: mean estimate, 12.54; 95% CI, 10.45-14.64; FP4: mean estimate, 12.98; 95% CI, 10.89-15.08; P = .16 for the FP association). However exploratory analyses of postprandial changes in FTOEs undertaken for each transfusion epoch separately found evidence of increased postprandial FTOEs during TE1 (mean [SD] FTOEs, 10.55 [5.5] at FP0 vs 13.21 [5.96] at FP4, P = .046). The primary and exploratory analyses found no association between FTOEc and feeding phases, suggesting that cerebral oxygenation may be protected.
Conclusions and Relevance: The findings suggest that enteral feeding may be associated with gut ischemia and potentially transfusion-associated necrotizing enterocolitis. The postprandial changes in FTOEs appear to warrant further investigation in larger randomized studies.
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المشرفين على المادة: S88TT14065 (Oxygen)
تواريخ الأحداث: Date Created: 20200229 Date Completed: 20200825 Latest Revision: 20200825
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC7049081
DOI: 10.1001/jamanetworkopen.2020.0149
PMID: 32108891
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2020.0149