Mesenteric Perfusion Pattern Changes as the Result of Packed Red Blood Cell Transfusions in Preterm Infants Open Access

Abstract

Abstract
Mesenteric Perfusion Pattern Changes as the Result of
Packed Red Blood Cell Transfusion in Preterm Infants
Necrotizing enterocolitis is the most serious gastrointestinal emergency encountered by
very low birth weight (VLBW) infants. Approximately half of the 4500 preterm
infants affected annually require surgical intervention, with associated mortality rates of 30%-50%.
Extensive research has determined that NEC pathogenesis is most likely
multifactorial; however, prematurity is the only definitive predictor. Clear predictive and prevention
strategies for this disease remain unknown and its incidence unchanged.
Recent evidence demonstrates a temporal relationship between packed red blood cell (PRBC)
administration and NEC development. Although the underlying pathophysiology of this occurrence is unknown, leading theories suggest gastrointestinal immaturity and the age of blood infused may substantially
increase the risk for transfusion-related NEC. Therefore, perfusion alterations as a result of changing
blood flow subsequent to transfusion and the age of blood administered may increase the risk for
ischemic insult.
This observational, prospective study endeavored to identify changes in mesenteric tissue
perfusion by monitoring differential tissue oxygenation using near-infrared spectroscopy in
preterm infants receiving blood transfusions. In addition, the relationship between the age of blood
infused and perfusion pattern alteration was observed.
Thirty-three transfusion events were observed. It was concluded that the most immature infants
demonstrated lower mesenteric perfusion following PRBC
administration. The administration of PRBCs greater than six days old was also associated with
decreased mesenteric perfusion. Four infants developed NEC temporally associated with PRBC
transfusions, occurring within 48 hours of blood infusion. Infants who developed transfusion-related
NEC were gestationally younger, more likely to have received enteral feedings during the transfusion,
received larger volumes of feedings and received greater volumes of blood than infants who did not
develop transfusion-related NEC.

Mesenteric Perfusion Pattern Changes as the Result of
Packed Red Blood Cell Transfusion in Preterm Infants
B.S.N., University of Tennessee, 1986
M.S.N., State University of New York, 2002
Advisor: Linda McCauley, PhD
A dissertation submitted to the Faculty of the
James T. Laney School of Graduate Studies of Emory University
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy in
Nursing
2012

Table of Contents

Table of Contents
Chapters









Page Nos.
I. Introduction.

Statement of the Problem .
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Study Purpose
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II. Background and Significance
Introduction
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Clinical Presentation of NEC
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Disease Management
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NEC Pathogenesis
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Genetics and NEC
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Transfusion-related NEC .
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Near-infrared Spectroscopy
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Conclusion
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III. Methodology
Design
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Study Variables .
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Recruitment and Setting .
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Sample and Sample Size .
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Instrumentation .
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Data Collection .
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Procedures
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Statistical Analysis
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IV. Results and Publications

Introduction
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Subject Enrollment
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Sample Characteristics
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Transfusion Event Characteristics .
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Transfused Packed Red Blood Cell (PRBC) Characteristics .
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Enteral Feeding Characteristics
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48
TR-NEC compared to non-NEC events
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Mesenteric Perfusion Patterns related to Transfusion Event .
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52
CSOR Patterns related to Transfusion Event
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54
Mesenteric Perfusion Patterns related to Enteral Feeding and Transfusion Event
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57
CSOR Patterns related to Enteral Feeding and Transfusion Event
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Mesenteric Perfusion Patterns related to Feeding Volume .
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Temporal Changes in Mesenteric Perfusion related to Feeding and Transfusion Events
63
Mesenteric Perfusion Patterns and the Age of Blood Infused
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65
Mesenteric Perfusion Patterns in TR-NEC cases
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68

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nursing
Keyword	necrotizing enterocolitis mesenteric perfusion transfusion prematurity
Committee Chair / Thesis Advisor	Strickland, Ora, Emory University McCauley, Linda, Emory University
Committee Members	Josephson, Cassandra D, Emory University Freeman, Sarah B, Emory University Moore, James, University of Texas Stoll, Barbara J, Emory University

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