TOP 28 - Effects of Blood Transfusion(s) on Gut Microbiome of Preterm Infants

Publication Number: 2779.TOP 28

Pei-Shan Lee, University of Maryland School of Medicine, Baltimore, MD, United States; Hnin Wai Lwin, University of Maryland School of Medicine, Baltimore, MD, United States; Bing Ma, University of Maryland, Baltimore, MD, United States; Sripriya Sundararajan, University of Maryland School of Medicine, Baltimore, MD, United States

Background: Red blood cell (RBC) transfusions are commonly administered to treat anemia of prematurity, and there is a potential association between RBC transfusion and the onset of necrotizing enterocolitis (NEC) within 48 hours post-transfusion. The gut microbiome plays a pivotal role in intestinal health and NEC pathogenesis, and is known to be influenced by anemia and RBC transfusion, among other factors. Investigating how anemia and transfusion affect the gut microbiome in preterm infants may yield important insights into the mechanisms of transfusion-associated NEC.

Objective: To examine the effects of anemia and RBC transfusion on the gut microbiome of preterm infants, we propose the following objectives: Primary

Objective: To compare gut microbiome changes before and after RBC transfusion. Secondary

Objective: To investigate associations between microbiome changes and comorbidities of prematurity, including but not limited to bronchopulmonary dysplasia, intraventricular hemorrhage, sepsis, PDA, retinopathy of prematurity, necrotizing enterocolitis, and feeding intolerance.

Design/Methods: A retrospective medical record review is conducted on a longitudinal prospective cohort of 159 preterm infants born between 24 and 32 weeks of gestation. Daily fecal samples were collected during the first 28 days of life. Approximately 30% (48/159) of infants received at least one red blood cell (RBC) transfusion within this period, and we were able to retrieve stool within three days before and after transfusion for 14 of them. Whole community metagenome sequencing was performed on these samples, and taxonomic profiling and functional pathways were constructed. In addition, detailed subject demographics information has also been collected.

We plan to conduct longitudinal analyses adjusting for time-varying covariates to evaluate for changes in microbial diversity and the temporal effects of transfusion, as well as investigate their associations with comorbidities of prematurity. Additionally, cross-sectional analyses will compare stool microbiome profiles based on postnatal antibiotic exposure and the infant's feeding regimen. Analysis is expected to be completed by January 2026.