Impact of red blood cell transfusions on intestinal barrier function in preterm infants.
Impact of red blood cell transfusions on intestinal barrier function in preterm infants.
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DOI：
10.3233/npm-1828
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发表时间：
2019
影响因子：
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通讯作者：
Sundararajan S
中科院分区：
文献类型：
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作者：
Ajayi OO;Davis NL;Saleem B;Kapoor S;Okogbule-Wonodi AC;Viscardi RM;Sundararajan S
目的探讨红细胞输注和肠道喂养与早产儿肠道通透性（IP）变化的关系，以乳果糖（La）和鼠李糖（Rh）的相对肠道摄取为指标。妊娠240- 326周的婴儿在研究第1、8和15天肠内接受La/Rh溶液。采用高效液相色谱法测定尿La/Rh比值。测定每个研究间隔（出生-d1; d1-d8和d8-d15）期间输血前的红细胞压积、总RBC输注量、体积/kg和喂养状态。在研究期间接受≥1次输血的17例（40.5%）受试者中，12例（70.6%）婴儿妊娠<28周，5例（29.4%）婴儿妊娠≥28周，p<0.0001。在高IP（La/Rh>0.05）测量之前的间隔中观察到的输血前红细胞压积低于低IP（La/Rh≤0.05）测量之前的间隔（33 vs 35.8，p=0.1051）。在高IP之前的间隔中RBC输注的发生频率高于低IP之前的间隔（26.8%; vs 8.3%，p=0.0275），在高IP的任何时间点之前的间隔中总RBC体积和体积/kg高5倍。在间隔期间输注RBC与高IP风险增加3倍相关（aOR 2.7; 95% C.I 0.564-12.814; p=0.2143）。纯母乳暴露和月经后年龄降低了红细胞输注后高IP的风险。RBC输注数量和体积均与妊娠<33周的早产儿随后的高IP测量值相关，并可能导致早产肠屏障受损。
To determine the relationships of red blood cell (RBC) transfusion and enteral feeding to changes in intestinal permeability (IP) measured by the relative intestinal uptake of lactulose (La) and rhamnose (Rh) in preterm infants <33 wk gestation. Infants 240–326wk gestation received La/Rh solution enterally on study days 1, 8 and 15. Urinary La/Rh ratio was measured by HPLC. Hematocrit preceding transfusion, total RBC transfusion volume, volume/kg, and feeding status during each study interval (birth-d1; d1-d8, and d8-d15) were determined. Of the seventeen (40.5%) subjects who received ≥1 transfusion during the study period, 12(70.6%) infants were <28 wk gestation and 5(29.4%) infants were ≥28 wk gestation, p<0.0001. Lower pre-transfusion hematocrit was observed in intervals preceding high IP (La/Rh>0.05) than in intervals preceding low IP (La/Rh≤0.05) measurements (33 vs 35.8, p=0.1051). RBC transfusions occurred more frequently in intervals preceding high IP than in intervals preceding low IP (26.8%; vs 8.3%, p=0.0275) with 5-fold higher total RBC volume and volume/kg in intervals preceding any time point with high IP. RBC transfusion during an interval was associated with a three-fold increased risk of high IP (aOR 2.7; 95% C.I 0.564–12.814; p=0.2143). Exclusive breast milk exposure and post-menstrual age reduced the risk for high IP following RBC transfusion. Both RBC transfusion number and volume was associated with subsequent high IP measurements in preterm infants <33 weeks gestation and potentially may contribute to impairment of the preterm intestinal barrier.