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Transfusion to correct anemia of prematurity helpful in poor feeders: study

Reuters Health • The Doctor's Channel Daily Newscas

NEW YORK (Reuters Health) – Anemia of prematurity is associated with poor feeding and weight gain. A new study finds that correcting AOP with packed red blood cell transfusion improves feeding and boosts weight gain.

But Dr. Ruben Bromiker senior neonatologist, Shaare Zedek Medical Center, Jerusalem, Israel, told Reuters Health, “Correction of anemia of prematurity with packed red blood cell transfusion is not free of complications.”

“Today,” he wrote in an email, “there is a tendency to restrict transfusion, but some premature infants still must receive blood. In those infants suffering from anemia of prematurity, poor feeding and weight gain, together with other clinical signs, may be adjuvants in the decision to transfuse.”

“Many infants suffering from anemia of prematurity will have indications for transfusion other than feeding problems, therefore the whole picture, and not feeding as an isolate sign, must be evaluated,” Dr. Bromiker added.

He and his colleagues measured sucking patterns using the Kron Nutritive Sucking Apparatus in 36 anemic premature infants (34 weeks’ gestation or less) before and one to two days after they received 15 mL/kg of packed red blood cells.

According to a paper online June 4 in Archives of Pediatrics and Adolescent Medicine, overall, the researchers didn’t find any significant before-and-after differences in the number of sucks or other sucking parameters. Nor did they see significant changes in the amount of nutrient the babies ingested during the five minutes of the measurement before and after correction of AOP.

However, they did find a statistically significant increase in average daily weight gain during the week after transfusion relative to the week before (mean daily weight gain before and after 30.9 vs 36.5 g; p=0.02).

However, the results were different when the babies were stratified by baseline sucking performance.

In the subgroup of infants who had poor sucking at baseline, there was a significant improvement in number of sucks (p=0.006) and other sucking parameters and the volume of nutrient ingested (p=0.004).

“The fact that these changes occurred only in the poor feeders suggests that the most probable mechanism for the increase in the feeding amount was the increase in the number of sucks,” the authors say, and the transfusion of packed red blood cells “may have contributed significantly to this improvement.”

“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, although further data should be obtained to support this concept,” the investigators conclude.

Arch Pediatr Adolesc Med. 2012.