{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T22:35:34Z","timestamp":1788820534027,"version":"build-2803163510"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Preterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Near-infrared spectroscopy monitoring of Csat and Msat.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score &amp;lt;85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower\u2013hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher\u2013hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO\n 2<\/jats:sub>\n ) in either group (0.2% vs \u22120.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41;\n P<\/jats:italic>\n \u2009=\u2009.03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO\n 2<\/jats:sub>\n . Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia.\n <\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT01702805<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.34889","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T11:01:44Z","timestamp":1695294104000},"page":"e2334889","source":"Crossref","is-referenced-by-count":31,"title":["Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants"],"prefix":"10.1001","volume":"6","author":[{"given":"Valerie Y.","family":"Chock","sequence":"first","affiliation":[{"name":"Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children\u2019s Hospital, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haresh","family":"Kirpalani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward F.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Tan","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan R.","family":"Hintz","sequence":"additional","affiliation":[{"name":"Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children\u2019s Hospital, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Bethany","family":"Ball","sequence":"additional","affiliation":[{"name":"Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children\u2019s Hospital, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Smith","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhik","family":"Das","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne C.","family":"Loggins","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beena G.","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Wayne State University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina F.","family":"Chalak","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myra H.","family":"Wyckoff","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D.","family":"Kicklighter","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen A.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waldemar A.","family":"Carlo","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen J.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi L.","family":"Watterberg","sequence":"additional","affiliation":[{"name":"University of New Mexico Health Sciences Center, Albuquerque"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo J.","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbot R.","family":"Laptook","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth B.","family":"Seabrook","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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