Hemodynamic response to packed red blood cell transfusion in preterm infants with anemia: a prospective electrical cardiometry study

Background Preterm infants frequently require packed red blood cell (PRBC) transfusions, yet their immediate hemodynamic response remains poorly defined. Electrical cardiometry (ICON) might offer a noninvasive tool to characterize these changes better. Aim This study aimed to evaluate changes in hemodynamics-assessed by ICON parameters-while monitoring changes in vital signs before and after PRBC transfusion in anemic premature infants. Patients and methods The study was conducted on anemic preterm infants less than or equal to 36 weeks’ gestation who required PRBC transfusion. Complete blood counts, venous blood gases, vital signs, and hemodynamic parameters (assessed using ICON) were recorded at baseline (30 min pretransfusion) and 1 h post-transfusion. Results Post-transfusion, the overall cohort showed a significantly increased systolic blood pressure and oxygen saturation, a decreased heart rate, a reduced ICON score ( P =0.009), and an elevated systemic vascular resistance index (SVRI) ( P =0.001), while other parameters remained stable. ICON score significantly decreased ( P =0.009) and the SVRI significantly increased ( P =0.006) in survivors. In contrast, nonsurvivors exhibited a blunted response, with no significant change in ICON score and only a modest rise in SVRI. Conclusion PRBC transfusion produces clear hemodynamic patterns in anemic preterm infants, and continuous ICON monitoring can help identify those with limited cardiac reserve. A failure to reduce myocardial workload after transfusion may serve as an early ominous sign of diminished cardiac reserve and critical illness in this vulnerable population.