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Author Notes:

Corresponding author: Terri Main, tmarin@augusta.edu

TM composed the initial draft of this manuscript and revised accordingly after receiving input from all co-authors.

TM was a major participant in research project design for NIRS data collection, analysis and interpretation.

RM made substantial contributions to research project conception and design, had major contributions to manuscript development and finalization, and gave approval of final manuscript.

JDR made substantial contributions to research project design, preliminary data acquisition and analysis, drafting methods portion related to metabolomics and gave approval of final manuscript.

SRS made substantial contributions to research project design, preliminary data acquisition and analysis, drafting methods portion related to metabolomics and gave approval of final manuscript.

YG made substantial contributions to statistical analysis including software development, power analysis, and development of statistical methods portion of manuscript.

YG gave approval of final manuscript.

KE made substantial contributions to statistical analysis including software development, sample size and power estimates, and development of statistical methods portion of manuscript.

KE gave approval of final manuscript.

MW has major responsibility for data acquisition, data management, and participant consent.

She authored the data management portion of the final manuscript.

JS has major responsibility for data acquisition, data management, and participant consent.

She assisted with authoring data management and quality control section of the final manuscript.

CDJ made substantial contributions to research project conception and design relative to red blood cell characteristics to be analyzed, how irradiation storage time may affect these changes and how it will be measured.

CDJ will be accountable and oversee all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

CDJ had major contributions to manuscript development and finalization, and gave approval of final manuscript.

All authors read and approved the final manuscript.

Our funding sponsors had no involvement in the study design, collection, interpretation or data analysis, writing of this report or decision for publication submission.

Dr. Marin is an educational consultant for Medtronic, Inc. Academic Affairs in which she educates clinical staff of proper bedside use of near-infrared spectroscopy technology. No other authors have any competing interests to disclose.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Subjects:

Research Funding:

The study described is supported by funding received from the National Institutes of Health, National Heart, Lung and Blood Institute PO1 grant [2PO1 HL086773].

We have received expedited approved under CFR.46.110 and/or 21CFR 56.110 by the Institutional Review Board of Emory University IRB00083691 to recruit participants for this study.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics
  • NECROTIZING ENTEROCOLITIS
  • PRETERM INFANTS
  • RANDOMIZED-TRIAL
  • NITRIC-OXIDE
  • TRANSFUSION
  • OUTCOMES
  • RISK
  • ASSOCIATION
  • OXYGENATION
  • HEMOGLOBIN

Does red blood cell irradiation and/or anemia trigger intestinal injury in premature infants with birth weight <= 1250 g? An observational birth cohort study

Tools:

Journal Title:

BMC Pediatrics

Volume:

Volume 18, Number 1

Publisher:

, Pages 270-270

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Necrotizing enterocolitis (NEC) is a leading cause of neonatal morbidity and mortality in premature infants. To date, no effective biomarkers exist to predict which premature infants will develop NEC, limiting targeted prevention strategies. Multiple observational studies have reported an association between the exposure to red blood cell (RBC) transfusion and/or anemia and the subsequent development of NEC; however, the underlying physiologic mechanisms of how these factors are independently associated with NEC remain unknown. Methods: In this paper, we outline our prospective, multicenter observational cohort study of infants with a birth weight ≤ 1250 g to investigate the associations between RBC transfusion, anemia, intestinal oxygenation and injury that lead to NEC. Our overarching hypothesis is that irradiation of RBC units followed by longer storage perturbs donor RBC metabolism and function, and these derangements are associated with paradoxical microvascular vasoconstriction and intestinal tissue hypoxia increasing the risk for injury and/or NEC in transfused premature infants with already impaired intestinal oxygenation due to significant anemia. To evaluate these associations, we are examining the relationship between prolonged irradiation storage time (pIST), RBC metabolomic profiles, and anemia on intestinal oxygenation non-invasively measured by near-infrared spectroscopy (NIRS), and the development of NEC in transfused premature infants. Discussion: Our study will address a critical scientific gap as to whether transfused RBC characteristics, such as irradiation and metabolism, impair intestinal function and/or microvascular circulation. Given the multifactorial etiology of NEC, preventative efforts will be more successful if clinicians understand the underlying pathophysiologic mechanisms and modifiable risk factors influencing the disease.

Copyright information:

© 2018 The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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