Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1464-1466 (doi:10.1542/peds.2005-3197)
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Right arrow Premature & Newborn

Poor Circulation, Early Brain Injury, and the Potential Role of Red Cell Transfusion in Premature Newborns

Chad C. Andersen, MBBS, FRACP
Clare Louise Collins, MRCP
Department of Paediatrics
Mercy Hospital for Women
Heidelberg, Victoria 3084, Australia

The first 20% of the full text of this article appears below.

To the Editor.—

It is the purpose of this letter to (1) define poor circulation in very premature newborns, (2) discuss the concept of stagnant hypoxia and its relation to early brain injury, and (3) discuss the potential role of adult packed red cell transfusion as an acute intervention for poor circulation.

POOR CIRCULATION

There is no simple definition of poor circulation in newborns. It may be pragmatically described by the presence of 1 of the following: low cardiac output (CO) on echocardiography,1 profound hypotension with capillary refill time of ≥3 seconds,2 or hypoxemia resulting in elevated serum lactate.3

STAGNANT HYPOXIA

There are a number of different forms of hypoxia, namely, stagnant (inadequate flow), anemic (inadequate hemoglobin concentration), hypoxic (inadequate inspired oxygen), and histotoxic hypoxia. Barcroft first described stagnant hypoxia in 19204 with the sentence "[the] blood is normal but is supplied to the tissues in insufficient quantities."

The principal determinants of systemic oxygen transport are CO, hemoglobin concentration, and hemoglobin saturation.5 Final tissue oxygen extraction depends on the oxygen diffusion gradient, the diffusion distance between the capillary and the cell, and cellular uptake mechanisms.

The . . . [Full Text of this Article]