Transcript Slide 1

Sucking Improvement Following
Blood Transfusion
for Anemia of Prematurity
Bromiker R, Kasinetz Y, Kaplan M, Hammerman C, Schimmel M, MedoffCooper B. Sucking improvement following blood transfusion for anemia of
prematurity. Arch Pediatr Adolesc Med. Published online June 4, 2012.
doi:10.1001/archpediatrics.2012.676.
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Introduction
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Background
– Anemia of prematurity (AOP) may be responsible for an impairment in
different activities because of diversion of oxygen delivery and energy
supplies to other vital functions.
– Nutritive sucking activity involves the integration of multiple central
nervous system sensory and motor functions.
– Symptomatic anemia may impair the normal development of nutritive
sucking in premature babies.
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Study Objective
– To determine whether correction of AOP by packed red blood cell
transfusion improves sucking.
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Methods
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Study Design
– Nonexperimental intervention study.
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Setting
– Neonatal intensive care unit of Shaare Zedek Medical Center, Jerusalem, Israel,
between July 23, 2006, and December 16, 2007.
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Patients
– 36 Neonates at gestational age ≤34 weeks, feeding orally, who developed AOP
(hematocrit ≤27% if not receiving oxygen or ≤35% if receiving oxygen).
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Intervention
– Packed red blood cell transfusion, 15 mL/kg.
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Main Outcome Measures
– Change in sucking parameters recorded with Kron Nutritive Sucking Apparatus for
5 minutes and ingested volume, prior to and 1-2 days after intervention.
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Methods
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Limitations
– No formal investigation has been conducted to establish whether a
correlation exists between hemoglobin levels and suckling abilities prior
to correction of AOP.
– Possibility of:
• Spontaneous maturational sucking improvement between
measurements.
• Circadian variations in sucking (technical factors made
standardization of the daily timing of sucking measurements
difficult).
• Influence of the statistical phenomenon of regression toward the
mean.
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Results
Demographic and Feeding Features of 36 Infants
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Results
Comparison of Sucking Parameters and Average Daily
Weight Gain Before and After Transfusion in 36 Infants
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Results
Demographic Features of
Subgroups Based on
Median Number of Sucks
Before Correction of AOP
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Results
Comparison of Sucking
Parameters Over 5 Minutes
Before and 24-48 Hours
After Blood Transfusion
Within Groups
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Comment
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Correction of anemia with blood transfusion:
– Did not change sucking volume ingested by premature infants who were
good feeders prior to the transfusion.
– Improved sucking and volume ingested by premature infants who were
poor feeders prior to the transfusion.
– Enhanced average daily weight gain in all premature infants.
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Comment
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Poor feeding and failure to gain weight may be considered as adjuncts to
hematological parameters in the decision-making process as to whether to
transfuse premature infants for AOP.
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Prospective data should be obtained to evaluate this hypothesis.
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Contact Information
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If you have questions, please contact the corresponding author:
– Ruben Bromiker, MD, Department of Neonatology, Shaare
Zedek Medical Center, PO Box 3235, Jerusalem, Israel
([email protected]).
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