Minute-by-minute systemic hemodynamic responses to packed red blood cell transfusion in extremely low gestational age neonates: a prospective cohort study

This study is the first to apply Electrical Velocimetry (EV) for continuous, high-resolution monitoring of systemic hemodynamic (SH) parameters before, during, and after packed red blood cell transfusion (PRBCT) in extremely low-gestational-age neonates (ELGANs). The findings demonstrate measurable minute-by-minute fluctuations in cardiac contractility, stroke volume, cardiac output and vascular resistance temporally associated with transfusion. These fluctuations occurred even in infants who were hemodynamically stable at baseline, suggesting that EV may detect transfusion-related physiological variability not captured by routine monitoring, without implying a direct causal effect. Advanced monitoring technologies, such as EV, may enable more accurate and individualized neonatal care. To optimize outcomes for this vulnerable population and refine transfusion guidelines, further research including larger prospective studies and randomized controlled trials are needed.