Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised?

Objectiveto determine the impact of progressive anemia of prematurity on cerebral regional saturation (c-rso2) in preterm infants and identify the hemoglobin threshold below which a critical decrease (>2sd below the mean) in c-rso2 occurs.study designin a cohort of infants born ≤30 weeks ega, weekly c-rso2 data were prospectively collected from the second week of life through 36 weeks post-menstrual age (pma). clinically obtained hemoglobin values were noted at the time of recording. recordings were excluded if they were of insufficient duration (<1 h) or if the hemoglobin was not measured within 7 days. statistical analysis was performed using a linear mixed effects-model and roc analysis. roc analysis was used to determine the threshold of anemia, where c-rso2 critically decreased >2sd below the mean normative value (<55%) in preterm infants.resultsin total 253 recordings from 68 infants (mean ega 26.9 ± 2.1 weeks, bw 1025 ± 287 g, 49% male) were included. approximately 29 out of 68 infants (43%) were transfused during hospitalization. mixed-model statistical analysis adjusting for ega, bw, and pma revealed a significant association between decreasing hemoglobin and c-rso2 (p < 0.01) in transfusion-naive infants but not in transfused infants. in the transfusion naive group, using roc analysis demonstrated a threshold hemoglobin of 9.5 g/dl (auc 0.81, p < 0.01) for critical cerebral desaturation in preterm infants.conclusionsin transfusion-naive preterm infants, worsening anemia was associated with a progressive decrease in cerebral saturations. analysis identified a threshold hemoglobin of 9.5 g/dl below which c-rso2 dropped >2sd below the mean.