Volume replacement in the case of neonatal shock represents a rapid and difficult decision. The hematocrit and blood pressure often could not help in this decision.
To present situations in which the regional cerebral oxygen saturation(cRSO2) and fractional tissular oxygen extraction(FTOE) could aid in the decision for blood transfusion in neonates with different forms of shock
There are presented several cases of neonatal circulatory failure in which blood transfusion was indicated. There are noted the values of hematocrit, blood pressure, capillary refill time and cRSO2 and cerebral FTOE. There are presented two cases of pulmonary hemorrhage, one cord blood hemorrhage, one case of digestive hemorrhage and one case of perinatal asphyxia because of placental abruption.
All cases had signs of shock :pallor, cold extremities, increased capillarry refill time and tachypnea, blood pressure was normal and did not predict the need for transfusion. The hematocrit was decreased immediately after pulmonary hemorrhage but not after the cord blood hemorrhage. The cRSO2 was the strongest predictor of need of transfusion in all the cases, decreasing in about 20 minutes with more than 20% from the baseline, the periferal SO2 being normal all the time. The cRSO2 came back to normal values after the transfusions in all the cases.
The cRSO2 are a sensitive predictor in the case of acute anemia in this series of cases and could help in the decision of a timely and efficient transfusion in the neonates with shock.