Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction

Halana V. Whitehead, Zachary A. Vesoulis, Akhil Maheshwari, Ami Rambhia, Amit M. Mathur

Research output: Contribution to journalArticle

Abstract

Background: Elevated cerebral fractional tissue oxygen extraction (cFTOE) is an adaptation to anemia of prematurity (AOP). cFTOE ≥0.4 is associated with brain injury in infants ≤30 weeks. This longitudinal study sought to investigate the utility of cFTOE in the evaluation of AOP. Methods: Infants ≤30 weeks estimated gestational age (EGA) underwent weekly hemoglobin, cerebral saturation, and pulse oximetry recordings from the second through 36 weeks post-menstrual age (PMA). Recordings were excluded if they were under 1 h or if hemoglobin was not measured within 7 days of recording. Mean cFTOE was calculated for each recording. Statistical analysis used linear mixed-effects modeling and receiver operating characteristic analysis. Results: 144 recordings from 39 infants (mean EGA 27.6 ± 2.2 weeks, BW 1139 ± 286 g) were included of whom 39% (15/39) were transfused. The mean recording length was 2.8 ± 1.3 h. There was a significant negative correlation between hemoglobin and cFTOE (R = −0.423, p ≤.001). In a multivariate model, adjusting for EGA, PMA, and patent ductus arteriosus treatment the AUC was 0.821. A critical increase in cFTOE occurred at a hemoglobin level of 9.6 g/dL. Conclusions: AOP is associated with a critical increase in cFTOE that occurs at a significantly higher hemoglobin level than standard clinical thresholds for transfusion.

Original languageEnglish (US)
Article number104891
JournalEarly Human Development
Volume140
DOIs
StatePublished - Jan 2020

Fingerprint

Anemia
Oxygen
Hemoglobins
Gestational Age
Patent Ductus Arteriosus
Oximetry
ROC Curve
Brain Injuries
Area Under Curve
Longitudinal Studies

Keywords

  • Anemia of prematurity
  • Cerebral NIRS
  • Oxygen extraction
  • Prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction. / Whitehead, Halana V.; Vesoulis, Zachary A.; Maheshwari, Akhil; Rambhia, Ami; Mathur, Amit M.

In: Early Human Development, Vol. 140, 104891, 01.2020.

Research output: Contribution to journalArticle

Whitehead, Halana V. ; Vesoulis, Zachary A. ; Maheshwari, Akhil ; Rambhia, Ami ; Mathur, Amit M. / Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction. In: Early Human Development. 2020 ; Vol. 140.
@article{4251d02a30d1491ea42ed29f1a22f031,
title = "Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction",
abstract = "Background: Elevated cerebral fractional tissue oxygen extraction (cFTOE) is an adaptation to anemia of prematurity (AOP). cFTOE ≥0.4 is associated with brain injury in infants ≤30 weeks. This longitudinal study sought to investigate the utility of cFTOE in the evaluation of AOP. Methods: Infants ≤30 weeks estimated gestational age (EGA) underwent weekly hemoglobin, cerebral saturation, and pulse oximetry recordings from the second through 36 weeks post-menstrual age (PMA). Recordings were excluded if they were under 1 h or if hemoglobin was not measured within 7 days of recording. Mean cFTOE was calculated for each recording. Statistical analysis used linear mixed-effects modeling and receiver operating characteristic analysis. Results: 144 recordings from 39 infants (mean EGA 27.6 ± 2.2 weeks, BW 1139 ± 286 g) were included of whom 39{\%} (15/39) were transfused. The mean recording length was 2.8 ± 1.3 h. There was a significant negative correlation between hemoglobin and cFTOE (R = −0.423, p ≤.001). In a multivariate model, adjusting for EGA, PMA, and patent ductus arteriosus treatment the AUC was 0.821. A critical increase in cFTOE occurred at a hemoglobin level of 9.6 g/dL. Conclusions: AOP is associated with a critical increase in cFTOE that occurs at a significantly higher hemoglobin level than standard clinical thresholds for transfusion.",
keywords = "Anemia of prematurity, Cerebral NIRS, Oxygen extraction, Prematurity",
author = "Whitehead, {Halana V.} and Vesoulis, {Zachary A.} and Akhil Maheshwari and Ami Rambhia and Mathur, {Amit M.}",
year = "2020",
month = "1",
doi = "10.1016/j.earlhumdev.2019.104891",
language = "English (US)",
volume = "140",
journal = "Early Human Development",
issn = "0378-3782",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction

AU - Whitehead, Halana V.

AU - Vesoulis, Zachary A.

AU - Maheshwari, Akhil

AU - Rambhia, Ami

AU - Mathur, Amit M.

PY - 2020/1

Y1 - 2020/1

N2 - Background: Elevated cerebral fractional tissue oxygen extraction (cFTOE) is an adaptation to anemia of prematurity (AOP). cFTOE ≥0.4 is associated with brain injury in infants ≤30 weeks. This longitudinal study sought to investigate the utility of cFTOE in the evaluation of AOP. Methods: Infants ≤30 weeks estimated gestational age (EGA) underwent weekly hemoglobin, cerebral saturation, and pulse oximetry recordings from the second through 36 weeks post-menstrual age (PMA). Recordings were excluded if they were under 1 h or if hemoglobin was not measured within 7 days of recording. Mean cFTOE was calculated for each recording. Statistical analysis used linear mixed-effects modeling and receiver operating characteristic analysis. Results: 144 recordings from 39 infants (mean EGA 27.6 ± 2.2 weeks, BW 1139 ± 286 g) were included of whom 39% (15/39) were transfused. The mean recording length was 2.8 ± 1.3 h. There was a significant negative correlation between hemoglobin and cFTOE (R = −0.423, p ≤.001). In a multivariate model, adjusting for EGA, PMA, and patent ductus arteriosus treatment the AUC was 0.821. A critical increase in cFTOE occurred at a hemoglobin level of 9.6 g/dL. Conclusions: AOP is associated with a critical increase in cFTOE that occurs at a significantly higher hemoglobin level than standard clinical thresholds for transfusion.

AB - Background: Elevated cerebral fractional tissue oxygen extraction (cFTOE) is an adaptation to anemia of prematurity (AOP). cFTOE ≥0.4 is associated with brain injury in infants ≤30 weeks. This longitudinal study sought to investigate the utility of cFTOE in the evaluation of AOP. Methods: Infants ≤30 weeks estimated gestational age (EGA) underwent weekly hemoglobin, cerebral saturation, and pulse oximetry recordings from the second through 36 weeks post-menstrual age (PMA). Recordings were excluded if they were under 1 h or if hemoglobin was not measured within 7 days of recording. Mean cFTOE was calculated for each recording. Statistical analysis used linear mixed-effects modeling and receiver operating characteristic analysis. Results: 144 recordings from 39 infants (mean EGA 27.6 ± 2.2 weeks, BW 1139 ± 286 g) were included of whom 39% (15/39) were transfused. The mean recording length was 2.8 ± 1.3 h. There was a significant negative correlation between hemoglobin and cFTOE (R = −0.423, p ≤.001). In a multivariate model, adjusting for EGA, PMA, and patent ductus arteriosus treatment the AUC was 0.821. A critical increase in cFTOE occurred at a hemoglobin level of 9.6 g/dL. Conclusions: AOP is associated with a critical increase in cFTOE that occurs at a significantly higher hemoglobin level than standard clinical thresholds for transfusion.

KW - Anemia of prematurity

KW - Cerebral NIRS

KW - Oxygen extraction

KW - Prematurity

UR - http://www.scopus.com/inward/record.url?scp=85073718311&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073718311&partnerID=8YFLogxK

U2 - 10.1016/j.earlhumdev.2019.104891

DO - 10.1016/j.earlhumdev.2019.104891

M3 - Article

C2 - 31669878

AN - SCOPUS:85073718311

VL - 140

JO - Early Human Development

JF - Early Human Development

SN - 0378-3782

M1 - 104891

ER -