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This prospective observational study was conducted in the NICU of Alexandria University Maternity Hospital between March 2023 and December 2023. Clinically stable anemic preterm infants (n\u2009=\u200930) with hemoglobin\u2009&lt;\u20099.5 g\/dL and an indication for PRBC transfusion were included. Cerebral and mesenteric oxygenation were measured by NIRS before, during, and after transfusion. Superior vena cava flow (SVCF) and anterior cerebral artery (ACA) and celiac artery (CA) velocities were measured before and after transfusion. Comparative analyses were used to compare parameters before and after transfusion, and correlation tests were used to assess relationships between oxygenation and hemodynamic measures. SVCF, velocity\u2013time integral (VTI), and SVC diameter decreased significantly after transfusion (p\u2009&lt;\u20090.001). ACA peak systolic velocity (PSV), ACA end-diastolic velocity (EDV), and celiac artery PSV also decreased significantly after transfusion (p\u2009&lt;\u20090.001). Splanchnic and cerebral oxygenation metrics increased significantly, whereas oxygen consumption and fractional tissue oxygen extraction decreased significantly after transfusion (p\u2009&lt;\u20090.001). Delta changes in SVCF were correlated with splanchnic oxygenation metrics (p\u2009=\u20090.002\u20130.003), and heart rate was significantly correlated with both cerebral and splanchnic oxygenation metrics (p\u2009=\u20090.003\u20130.006). Cerebral and splanchnic oxygenation metrics, SpO2, SVC diameter, SVC VTI, SVCF, ACA PSV, ACA EDV, and celiac artery PSV changed significantly after blood transfusion in anemic preterm infants.<\/jats:p>","DOI":"10.1038\/s41598-026-53147-6","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T15:56:12Z","timestamp":1782230172000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated cerebro-splanchnic blood flow and regional oxygenation monitoring in transfused anemic preterm infants"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0426-9018","authenticated-orcid":false,"given":"Marwa Mohamed","family":"Farag","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesham Abd El Rahim","family":"Ghazal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohamed Said","family":"Abougabal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa Medhat","family":"Elsaudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"issue":"6","key":"53147_CR1","doi-asserted-by":"publisher","first-page":"2417431","DOI":"10.1001\/jamanetworkopen.2024.17431","volume":"7","author":"E Deschmann","year":"2024","unstructured":"Deschmann, E. et al. 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IRB no. 00012098; FWA no. 00018699. Written informed consent was obtained from the parents or authorized legal representatives of all participating newborns.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent for publication of anonymous patient data was obtained from the parents or authorized legal representatives of all participating newborns.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"19566"}}