title: Use of Esophageal Hemoximetry to Assess the Effect of Packed Red Blood Cell Transfusion on Gastrointestinal Oxygenation in Newborn Infants.
abstract: ObjectivesThere are no widely accepted methods of continuously monitoring gut oxygenation in the newborn during packed red blood cell transfusion. We investigated the use of an orally inserted light spectroscopy probe to measure lower esophageal oxyhemoglobin saturations (eStO2) before, during, and after transfusion and made comparisons with abdominal near-infrared spectroscopy (NIRS) and superior mesenteric artery (SMA) flow.Study DesignThirteen neonates with corrected gestational ages ranging from 22 weeks, 0 day to 37 weeks, 5 days were enrolled. eStO2and NIRS measurements were recorded continuously for a 25-hour period starting 1 hour prior to starting the 4-hour transfusion. Transabdominal ultrasound was used to measure SMA flow prior to, upon completion, and 20 hours after the transfusion.ResultsTwelve infants completed the study. eStO2was well-tolerated and was weakly (r = 0.06) correlated (p< 0.001) with NIRS. Compared with NIRS, eStO2demonstrated a markedly greater variation in oxyhemoglobin values. NIRS and SMA flow measurements did not change, while eStO2increased from 48 ± 5% and 45 ± 5% in the pre- and intratransfusion periods to 57 ± 4% in the posttransfusion period (p= 0.03).ConclusionMeasurement of eStO2is feasible in neonates and may provide a continuous and sensitive index of rapid changes in mesenteric oxygenation in this patient population.
authors.affiliation: Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.
authors.forename: Farha M
authors.initials: FM
authors.lastname: Vora
authors.affiliation: Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.
authors.forename: Judy
authors.initials: J
authors.lastname: Gates
authors.affiliation: Department of Pediatrics, University of California, Davis, California.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Gerard
authors.affiliation: Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.
authors.forename: Shawn
authors.initials: S
authors.lastname: Hanson
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of California, Davis, California.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Applegate
authors.affiliation: Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.|Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, California.
authors.forename: Arlin B
authors.initials: AB
authors.lastname: Blood
mesh_terms: D017707:Erythrocyte Transfusion / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D041981:Gastrointestinal Tract / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology; D008991:Monitoring, Physiologic / Q000379:methods; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption; D010108:Oxyhemoglobins / Q000032:analysis / Q000378:metabolism; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D013152:Splanchnic Circulation; D014463:Ultrasonography / Q000379:methods
chemical_list: D010108:Oxyhemoglobins; D010100:Oxygen