Impact of Blood Transfusion on Vital Signs and Cardiac Functions in Neonates with Anemia

Background: There is no clear objective hemoglobin or hematocrit (HCT) level below which blood transfusion is recommended in neonates. Moreover, hemodynamic measurements are not common in transfusion practice. The decision to transfuse is, therefore, frequently based on clinical signs and standard guidelines.
Objectives: To study the impact of blood transfusion on vital signs and cardiac functions in neonates with anemia
Patients & Methods: This cross-sectional study was conducted during the period from May 2023 to May 2024 on 40 preterm and full-term neonates less than 4 weeks of life of both sexes admitted to NICU at Al-Hussein University hospital Diagnosed as anemia and fulfilled the criteria of blood transfusion.
Results: The Results showed that the age ranged from 2 to 24 days with a mean of 8.7 ± 6.09 days. Gestational age ranged from 31 to 37 weeks with a mean of 33.5 ± 1.77 weeks. There were 14 (35%) males and 26 (65%) females. Weight ranged from 1.7 to 3.5 kg with a mean of 2.3 ± 0.41 kg. Length ranged from 41 to 50 cm with a mean of 44.6 ± 5.43 cm. Also, the causes of clinical instability of the studied patients were, 13 (32.5%) patients were subjected to continuous positive airway pressure with FiO2 >40% aged less than 7 days with Hb below 13 gm , 7 (17.5%) patients had early-onset sepsis with vasopressor support aged 8 to 14 days with Hb below 9 gm/dl,1 (7.5%) patients had late-onset sepsis with vasopressor support aged 20 days with Hb below 7 gm/dl , 12 (30%) patients were subjected to mechanical ventilation aged less than 7 days with Hb below 13 gm/dl, 5 (12.5%) patients had nasal catheter with vasopressor support aged 8 to14 days with Hb below 9 gm/dl, and 2 (5%) patients had surgery (imperforated anus) aged less than 7 days with Hb below 13 gm/dl. Respiratory rate before transfusion ranged from 45-63 breath\minute with a mean 53.2 ± 4.16 and after transfusion 45-60 breath\minute with a mean 51.8 ± 4 (P<0.001) , heart rate before transfusion ranged from 170-210 beat\minute with a mean 184.4 ± 6.81 and after transfusion from 140-163 beat\minute with a mean 154.7 ±5.83 (P<0.001), oxygen saturation before transfusion ranged from 91-96 % with a mean 93.7 ± 1.43 and after transfusion from 93-97 % with a mean 94.4 ±1.24 (P<0.001), MAP before transfusion ranged from 51_67 mmhg with a mean 59.3 ± 4.64 and after transfusion from 51-67 mmhg with a mean 60.3 ±4.36 (P<0.001), Ejection fraction before transfusion ranged from 51-69 % with a mean 60.2 ± 5.52 and after transfusion from 52-69 with a mean 61.4 ±5.61 (P<0.001), LVET before transfusion ranged from 170-239 ms with a mean 189.9 ± 20.82 and after transfusion from 162-264 with a mean 218.4 ±28.38 (P<0.001), stroke volume before transfusion ranged from 3.2-5.2 ml with a mean 4.3 ± 0.58 and after transfusion from 3.2-5.4 ml with a mean 4.4 ±0.57 (P<0.001), and fractional shortening before transfusion ranged 32-50% with a mean 37.1±2.85 and after transfusion from 35-41% with a mean 38.6 ±1.77 (P<0.001) , cardiac output before transfusion ranged from 0,61-0.97 L\m with a mean 0.8 ± 0.1 and after transfusion from 0.56-0.85L\m with a mean 0.7±0.08 (P<0.001)
Conclusion: The study revealed that Blood transfusion improves the clinical symptoms in neonates with anemia and showed Significantly higher oxygen saturation, MAP, lower heart rate and respiratory rate and significant effect on the heart function including; increase in EF, LVET, SV, Fs and decrease in cardiac output.