Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with an increase in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH.


We prospectively enrolled infants less than 30 weeks' gestation age. PI and oxygen saturation (SpO2) were monitored with high‐resolution pulse oximeters 24 hours before and after RBC transfusion. Data were analyzed at three postnatal periods: Epoch 1, first week of life (1 to 7 days of life); Epoch 2, 2 to 4 weeks of life (8 to 28 days of life); and Epoch 3, 4 to 8 weeks of life.


A total of 118 transfusions were analyzed. IH measures significantly decreased after transfusion in Epochs 2 and 3. PI significantly increased after transfusion, but it did not correlate with the decrease in IH measures. Mechanical ventilation, fraction of inspired oxygen (FiO2), and IH measures influenced the effects on oxygenation.


RBC transfusion improved IH after the first week of life. The benefit in IH did not correlate with PI increase after transfusion. Pretransfusion respiratory support and IH measures predicted the effect of transfusion on oxygenation.

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Notes/Citation Information

Published in Transfusion, v. 58, issue 11, p. 2538–2544.

© 2018 AABB

This is the peer reviewed version of the following article: Ibonia, K.T., Bada, H.S., Westgate, P.M., Gomez‐Pomar, E., Bhandary, P., Patwardhan, A., & Abu Jawdeh, E.G. (2018). Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia. Transfusion, 58(11), 2538-2544, which has been published in final form at https://doi.org/10.1111/trf.14808. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

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This project described was supported by the National Center for Research Resources, UL1RR033173, and is now at the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH and The Gerber Foundation.