Minute-by-minute systemic hemodynamic responses to packed red blood cell transfusion in extremely low gestational age neonates: a prospective cohort study

BACKGROUND: Packed red blood cell transfusion (PRBCT) is a common intervention for neonatal anemia, primarily guided by hemoglobin thresholds. Electrical velocimetry (EV) portable, non-invasive impedance cardiography tool, provides continuous systemic hemodynamics (SH) parameter measurements, offering valuable insights into the physiological effects of transfusions. METHODS: This prospective, observational cohort study, conducted between May 2021 and October 2023, included 30 extremely low gestational age neonates requiring elective PRBCT during their neonatal intensive care unit stay. Using EV, 11 SH parameters were continuously recorded over 31 hours: 4 hours before, 3 hours during, and 24 hours after transfusion. The effect of transfusion on these parameters was assessed using ARIMA, paired t-tests and mixed linear models. RESULTS: Of the 30 infants, 20 were