Study on Transfusion Effects in Preterm infants

Neonatal anemia is common in preterm infants. Anemia may lead to hypoxia, possibly resulting in cell damage. A red blood cell (RBC) transfusion is an intervention aiming to rapidly improve oxygen transport to vital organs, such as the brain and the gut.

Anemia and RBC transfusions result in low and high organ oxygenation respectively. Both might be harmful, and especially high variation in oxygenation may lead to damage in vulnerable organs, such as the brain and the gut. As erythropoiesis is partly upregulated by hypoxia, there might be an association between these oxygenation values and the expression of erythropoietin (epo), which is the essential growth factor for the production of erythrocytes. Anemia leads to decreased oxygen transport and decreased organ oxygenation, whereas RBC transfusion increases oxygenation. It is unknown whether anemia and/or RBC transfusion are related to the expression of epo in gut cells through these various levels of oxygenation. We will therefore explore whether epo regulation and expression in intestinal cells may be associated with the course of hemoglobin (Hb) levels. Furthermore, we will explore if epo regulation and expression may also be associated with anemia, RBC transfusions, oxidative stress, and organ oxygenation in the neonatal period. Secondary, we will evaluate the clinical consequences and the neurological outcome of the variable oxygenation levels.

The objective is to explore whether epo regulation and expression, at the age of two weeks after birth and three to six months post-term, are associated with the course of Hb levels, anemia, RBC transfusions, oxidative stress, and cerebral and intestinal oxygenation in preterm infants during the early neonatal period.

The duration of the study will be from informed consent, followed by inclusion (after admission to the NICU) until three to six months post-term. The study period at the NICU will be for a maximum of four weeks. During the study period at the NICU the patients will undergo several non-invasive measurements.

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