Packed red blood cell transfusion (PRBC) attenuates intestinal blood flow responses to feedings in pre-term neonates with normalization at 24 hours (original) (raw)
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Archives of Disease in Childhood - Fetal and Neonatal Edition, 1994
Anaemia may increase the risk of tissue hypoxia in preterm infants. The effect of transfusion on circulation was studied in 33 preterm infants with a mean (SD) gestational age of 29 (5) weeks (range 26-34), birth weight 1153 (390) g (range 520-1840), and postnatal age of 48 (21) days (range 19-100). Packed cell volume, blood viscosity (capillary viscometer), cardiac output, and cerebral blood flow velocities in the internal carotid artery, anterior cerebral artery, and coeliac trunk (Doppler ultrasound) were determined before and after transfusion of 10 ml/kg of packed red blood cells. Transfusion increased packed cell volume from a mean (SD) 0.27 (0.45) to 0.37 (0.48). Mean arterial blood pressure did not change while heart rate decreased significantly from 161 (14) l/min to 149 (12). Cardiac output decreased from 367 (93) ml/kg/min to 311 (74) due to decrease in stroke volume from 2.28 (0.57) ml/kg to 2.14 (0.46) and in heart rate. There was a significant increase in systemic red ...
BMC Pediatrics, 2012
Background: IUGR infants are thought to have impaired gut function after birth, which may result in intestinal disturbances, ranging from temporary intolerance to the enteral feeding to full-blown NEC. In literature there is no consensus regarding the impact of enteral feeding on intestinal blood flow and hence regarding the best regimen and the best rate of delivering the enteral nutrition. Methods/design: This is a randomized, non-pharmacological, single-center, cross-over study including 20 VLBW infants. Inclusion criteria * Weight at birth ranging: 700-1501 grams * Gestational age up to 25 weeks and 6 days * Written informed consent from parents or guardians Exclusion criteria * Major congenital abnormality * Patients enrolled in other trials * Significant multi-organ failure prior to trial entry * Pre-existing cutaneous disease not allowing the placement of the NIRS' probe
Acta Paediatrica, 2004
Aims-To evaluate whether serial Doppler measurements of superior mesenteric artery (SMA) blood flow velocity after the first enteral feed could predict early tolerance to enteral feeding in preterm infants. Methods-When clinicians decided to start enteral feeds, Doppler ultrasound blood flow velocity in the SMA was determined before and after a test feed of 0.5 ml milk. The number of days taken for infants to tolerate full enteral feeding (150 ml/kg/ day) was recorded. Results-Fourteen infants (group 1) achieved full enteral feeding within seven days. Thirty infants (group 2) took 8-30 days. There was no diVerence in the preprandial time averaged mean velocity (TAMV) between the groups at a median age of 3 (2-30) days. In group 1, there was a significant increase in TAMV (p<0.01) above the preprandial level at 45 and 60 minutes, but this did not occur in group 2. An increase in TAMV by more than 17% at 60 minutes has a sensitivity of 100% and a specificity of 70% for the prediction of early tolerance to enteral feeds. Conclusions-There is a significant correlation between an increase in mean SMA blood flow velocity and early tolerance of enteral feeding. Doppler measurements of SMA blood flow velocity may be useful for deciding when to feed high risk preterm infants.
Paediatrica Indonesiana
Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance. Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them. Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at < 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of < 0.05 considered significant. Results We examined 156 infants eligible for the study. PSV, EDV, an...
Pediatric Research, 1994
We investigated early postnatal changes of the mesenteric circulation and its relationship to the systemic circulation in two groups of newborn infants. Group I (n = 10) was studied before the first feeding at 1 h and preprandially at 6 and 24 h. Group I1 (n = 10) was studied before the first feeding at 2 h of age and preprandially and postprandially at d 3, 4, and 5. Blood flow velocity was measured with ultrasound Doppler in the superior mesenteric artery (SMA), middle cerebral artery, subclavian artery, and aortic orifice for cardiac output (CO) calculations. Blood pressure and heart rate were monitored. SMA mean velocity (Vmean) decreased from 1 [0.33 5 0.07 m/s (mean -c SD)] to 6 h (0.23 -c 0.08 m/s,p c 0.005) in group I, probably due to ductal steal, returning to the 1-h value at 24 h. In contrast, middle cerebral artery Vmean remained unchanged in the first 24 h. From d 3, SMA Vmean increased 92% postprandially, with no relation to increasing amounts of food. The postprandial increase in SMA Vmean was not associated with changes in CO and blood pressure; however, a fall in relative mesenteric vascular resistance suggested regional redistribution of CO. Middle cerebral artery Vmean increased from h 2 to d 3 with a further increase on d 4 (p < 0.01). This increase was associated with an increase in blood pressure. The relative fraction of CO to middle cerebral artery increased during the first days of life, suggesting a redistribution of blood flow to the metabolically active organs in the neonatal period. (Pediufr Res 36: 334-339, 1994) Abbreviations Vmean, mean velocity BFV, blood flow velocity EDFV, end diastolic flow velocity During the first days of life, the intestinal circulation must adapt to feeding and to changes occurring in the postnatal transitional circulation. Ultrasound imaging and Doppler techniques permit noninvasive studies of the circulatory adaptive changes during the early period after birth. Studies on superior mesenteric artery BFV by Van Be1 e t al.
International Journal of Advanced Research, 2019
Preterm very low birth infants are not fed early if there is shock or severe sepsis or respiratory distress. Traditionally if infants are sick enteral feedings are introduced slowly (at 4-5 days of age). Infants born with history of AREDF are given parenteral nutrition till enteral intake is adequate (7-10 days). We studied the effect of early MEN (at 24 hours of age) in VLBW (<32 weeks gestation) infants with AREDF (MEN group-n=12;controls-n=14). The results of this study reveals that the outcome of infants fed with early MEN is better with shorter length of stay, faster regaining of birth weight, shorter duration of parenteral nutrition and better tolerance of feedings. These data suggest that early MEN can be safely implemented in preterm VLBW infants with history of AREDF with no adverse outcomes.
Pediatric Radiology, 2009
Background Doppler US to measure abdominal blood flow velocities (ABFV) is increasingly used to investigate intestinal haemodynamics in several clinical conditions in neonates. Studies that provide reference values of ABFV during the entire neonatal period are currently lacking. Objective To make available normal reference values of ABFV and Doppler indices in the coeliac trunk and superior mesenteric artery during the first month of life in term and healthy preterm infants. Materials and methods ABFV were obtained with colour Doppler US in 69 neonates (12 term, 57 preterm) divided into four gestational age groups (25-28 weeks, 29-32 weeks, 33-36 weeks, and 37-41 weeks). Results ABFV increased with increasing gestational and postnatal age. We also provide normal reference values of ABFV and Doppler indices to compare with measurements of abdominal blood flow changes during the neonatal period for diagnostic, therapeutic and prognostic purposes.