Cardiac implications of red blood cell transfusion in premature neonates: Focus on left ventricular function by echocardiographic strain measurements

Background Global longitudinal strain (GLS) has gained traction as a valuable parameter for assessing left ventricular function in premature neonates. However, as a load-dependent measure, its interpretation may be confounded by fluctuations in hemodynamic status. Cardiologists frequently assess neonates undergoing Packed Red Blood Cell (PRBC) transfusions. An improved understanding of the impact of such transfusions on strain measurements is essential to ensure accurate clinical interpretation. Purpose The aim of this study was to evaluate whether PRBC transfusions affect strain measurements in preterm neonates. Methods We prospectively enrolled 17 preterm neonates with anemia requiring PRBC transfusion were prospectively enrolled in this present study. A standardized transfusion protocol was employed, administering 15 mL/kg of PRBCs over a period of 2 to 3 hours. Standardized echocardiographic assessment for myocardial strain analyses were conducted one hour prior to and 30 minutes following the PRBC transfusion. Results The mean gestational age at birth was 28.9±3,2 weeks and echocardiographic assessment was performed at a mean of 26.3±16.5 days after birth. The pre-transfusion GLS was −20.1%, compared to −19.5% after transfusion (p=0,146). Figures 1 and 2 illustrates strain measurements and the individual changes in GLS for each neonate. Conclusion GLS measurements remained stable following PRBC transfusion in preterm neonates. An understanding of the impact of different load alterations on strain measurements is essential for accurate clinical interpretation. We recommend further studies to investigate the effects of other hemodynamic changes on strain measurements in neonates, with the aim of enhancing their clinical applicability and interpretability.