Increased oxidative stress post-blood transfusion in preterm small for gestation infants compared to appropriate for gestation infants
Thursday, February 13, 2020
2:45 PM – 3:00 PM
Location: Max Bell Auditorium
Introduction: Compared to appropriate for gestation (AGA) infants, small for gestation (SGA) infants are at higher risk of bronchopulmonary dysplasia and retinopathy of prematurity, diseases associated with oxidative stress. Although blood transfusions are associated with oxidative stress, it is unknown how SGA and AGA infants react to blood transfusions. To objective of this study is to determine oxidative stress in SGA and AGA infants after blood transfusion.
Methods: This is a prospective observational study of infants <30 weeks gestation at birth who received blood transfusion. Exclusion criteria included any blood product administered within 3 weeks, sepsis, renal and liver disorders. Urine was collected pre-transfusion, and at 24-48 and 49-72 hours post-transfusion. ELISAs were used to measure urinary 8-OHdG, TBARs, and 8-isoprostane as markers of lipid peroxidation and DNA oxidative injury. Statistical analysis was performed using a two-way non-paired Student t test or Mann-Whitney test for continuous variables as appropriate and χ2 or Fisher's exact test for categorical variables. Linear regression was performed to adjust for confounders.
Results: There was significantly higher levels of urinary 8-OHdG in SGA infants compared to AGA infants at the two post-transfusion time points (Table 2). Oxidative stress was further increased in SGA infants at 49-72 hours whereas levels were declining in AGA infants (Table 2). Using a general linear model adjusted for gestational age, birthweight, post-natal age in days, sex, antenatal steroids and mode of delivery, the differences remained significant (P=.009 at 24-48 and P=.04 at 49-72 hours).
Conclusion: SGA infants have increased oxidative stress after blood transfusions which may contribute to the higher incidence of BPD and ROP in this population. Our data suggests that transfusing blood to SGA infants should be done judiciously.