Anemia Clinical Trial
Official title:
Prevention of Transfusion Related Acute Gut Injury (TRAGI) in Extremely Low Gestational Age Neonates (ELGAN) Neonates Using iNO
The investigators seek to determine whether providing inhaled nitric oxide (iNO; a vasodilator) will improve the delivery of oxygen to the brain, kidney and intestines of preterm neonates during and after the subject receives a packed red blood cell transfusion (PRBC) for anemia vs. baseline period. The investigators will observe the effect of inhaled nitric oxide vs. placebo at these body sites to determine whether iNO will alter the fractional tissue oxygen extraction. Treatment and control groups will be compared to each other at equivalent epochs as will individual patients before, during and after the PRBC transfusion.
Selection criteria: 1) Neonates 24 0/7 to 27 6/7 weeks gestational age (GA) 2) More than 2
weeks postnatal age. 3) Anemia with Hct less than 28 % 4) >50 % total daily fluids is enteral
5) History of at least 1 prior PRBC transfusion ELGANs admitted to the neonatal intensive
care unit (NICU) will be screened for the study. If patients meet the selection criteria,
parents will be approached to obtain informed consent. Then the patient will be randomized to
either iNO or placebo group before treatment. The treating physician will make the decision
regarding timing of the PRBC transfusion to treat anemia for the subject.
During the period of observation, near infrared spectroscopy (NIRS) monitoring will be
performed on all enrolled subjects during which a non-invasive probe will be attached to the
skin at 3 sites simultaneously- on abdomen below umbilicus, flank/back, and forehead for
calculation of fractional tissue oxygen extraction ( FTOE) in conjunction with concurrent
pulse oximetry recordings.
Conventional vital signs, blood gas, lactate, haptoglobin and cytokines will be measured
before and after the PRBC transfusion
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