Abstract
Hemoglobin levels (Hgb) of infants with a single ventricle (SV) are traditionally maintained high to maximize oxygen-carrying capacity during stage 1 palliation (S1P), stage 2 palliation (S2P), and between stages (IS). A single-center observational cohort study was performed to determine if red blood cell transfusion during the convalescent phase of the S1P (late S1P transfusion) to achieve higher Hgb is associated with benefits during the IS including improved growth and decreased acute medical events. 137 infants <1 year with SV with SIP undergoing care from January 2008 to June 2015 were retrospectively evaluated. 78 (57%) infants received a late S1P transfusion. Median Hgb at S1P discharge was 15.9 g/dL (IQR 14.7–17.1) and median Hgb S2P at admission was 15.3 g/dL (IQR 14–16.3). Median daily weight gain was 22 g/day during IS (IQR 17–26) and median daily length gain was 0.09 cm (IQR 0.06–0.11). Hgb at SIP discharge was not associated with IS growth or fewer IS acute events. However, late S1P transfusions were associated with illness severity at S1P and more complicated S1P care. Our data suggest that SV infants after S1P, who are steadily recovering, do not benefit from late transfusion to raise their hemoglobin level at discharge.
Similar content being viewed by others
References
Stainsby D, Jones H, Wells AW et al (2008) Adverse outcomes of blood transfusion in children: analysis of UK reports to the serious hazards of transfusion scheme 1996–2005. Brit J Haematol 141:73–79
Kuo J, Maher K, Kirshgbom P et al (2011) Red blood cell transfusion for infants with single-ventricle physiology. Pediatric Cardiol 32:461–468
R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. http://www.R-project.org/
Secher EL, Stensballe J, Afshari A (2013) Transfusion in critically ill children: an ongoing dilemma. Acta Anaesthesiol Scand 57:684–691
Blackwood J, Ar Joffe, Robertson CM et al (2010) Association of hemoglobin and transfusion with outcome after operations for hypoplastic left heart. Ann Thorac Surg 89:1378–1384
Salvin JW, Scheeurer MA, Laussen PC et al (2011) Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay. Ann Thorac Surg 91:204–210
Gupta P, King C, Benjamin L et al (2015) Association of hematocrit and red blood cell transfusion with outcomes in infants undergoing Norwood operation. Pediatr Cardiol 36:1212–1218
Rajasekaran S, Kort E, Hackbarth R et al (2016) Red cell transfusions as an independent risk for mortality in critically ill children. J Intensiv Care 4:2–9
Cholette J, Rubenstein J, Alfieris G et al (2011) Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatr Crit Care Med 12:39–45
Cholette JM, Mf Swartz, Rubenstein J et al (2017) Outcomes using a conservative versus liberal red blood cell transfusion strategy in infants requiring cardiac operation. Ann Thorac Surg 103:206–214
Gas-Bakker De, de Wilde Hazekamp et al (2013) Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensiv Care Med 39:2011–2019
Mazine A, Rached-D’Astous S, Ducruet T et al (2015) Blood transfusions after pediatric cardiac operations: a North American multicenter prospective study. Ann Thorac Surg 100:671–677
Tremblay-Roy JS, Poirier N, Ducruet T (2016) Red blood cell transfusion in the postoperative care of pediatric surgery: survey on stated practice. Pediatric Cardiol 37:1266–1273
Delgado-Corcoran C, Wolpert K, Lucas K et al (2016) Hematocrit levels, blood testing, and transfusion in infants after heart surgery. Pediatr Crit Care Med 11:1387–1394
Ohye RG, Sleeper LA, Mahoni L et al (2010) Comparison of shunt types in the Norwood procedure for single ventricle lesions. N Engl J Med 362:1980–1992
Tweddell JS, Ghanayem NS, Hoffman GM (2010) Pro: NIRS is: “standard of care” for postoperative management. Semin Thorac Cardiovascu Surg Pediatr Card Surg Ann 13:44–50
Ghanagyem NS, Wernovsky G, Hoffman GM (2011) Near-infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med. 12:S27–S32
Costello JM, Polito A, Brown DW et al (2010) Birth before 39 weeks’s gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 126:277–284
Costello JM, Pasquali SK, Jacobs JP et al (2014) Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 129:2511–2517
Hill GD, Heir DA, Bartz PJ et al (2014) Effect of feeding modality on interstage growth following stage 1 palliation: a report from the national pediatric cardiology quality improvement collaborative. J Thorac Cardiovas Surg 148:1534–1539
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Delgado-Corcoran, C., Frank, D.U., Bodily, S. et al. Hemoglobin Level at Stage 1 Discharge has No Impact on Inter-stage Growth and Stability in Single Ventricle Infants. Pediatr Cardiol 38, 1505–1514 (2017). https://doi.org/10.1007/s00246-017-1692-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-017-1692-8