1. Sucking Improvement Following Blood Transfusion for Anemia of Prematurity Bromiker R, Kasinetz Y, Kaplan M, Hammerman C, Schimmel M, Medoff- Cooper B. Sucking improvement following blood transfusion for anemia of prematurity. Arch Pediatr Adolesc Med. Published online June 4, 2012. doi:10.1001/archpediatrics.2012.676. Copyright restrictions may apply

2. Background –Anemia of prematurity (AOP) may be responsible for an impairment in different activities because of diversion of oxygen delivery and energy supplies to other vital functions. –Nutritive sucking activity involves the integration of multiple central nervous system sensory and motor functions. –Symptomatic anemia may impair the normal development of nutritive sucking in premature babies. Study Objective –To determine whether correction of AOP by packed red blood cell transfusion improves sucking. Copyright restrictions may apply Introduction

3. Study Design –Nonexperimental intervention study. Setting –Neonatal intensive care unit of Shaare Zedek Medical Center, Jerusalem, Israel, between July 23, 2006, and December 16, 2007. Patients –36 Neonates at gestational age ≤34 weeks, feeding orally, who developed AOP (hematocrit ≤27% if not receiving oxygen or ≤35% if receiving oxygen). Intervention –Packed red blood cell transfusion, 15 mL/kg. Main Outcome Measures –Change in sucking parameters recorded with Kron Nutritive Sucking Apparatus for 5 minutes and ingested volume, prior to and 1-2 days after intervention. Copyright restrictions may apply Methods

4. Limitations –No formal investigation has been conducted to establish whether a correlation exists between hemoglobin levels and suckling abilities prior to correction of AOP. –Possibility of: Spontaneous maturational sucking improvement between measurements. Circadian variations in sucking (technical factors made standardization of the daily timing of sucking measurements difficult). Influence of the statistical phenomenon of regression toward the mean. Copyright restrictions may apply

5. Results Demographic and Feeding Features of 36 Infants Copyright restrictions may apply

6. Results Comparison of Sucking Parameters and Average Daily Weight Gain Before and After Transfusion in 36 Infants Copyright restrictions may apply

7. Results Demographic Features of Subgroups Based on Median Number of Sucks Before Correction of AOP Copyright restrictions may apply

8. Results Comparison of Sucking Parameters Over 5 Minutes Before and 24-48 Hours After Blood Transfusion Within Groups Copyright restrictions may apply

9. Comment Correction of anemia with blood transfusion: –Did not change sucking volume ingested by premature infants who were good feeders prior to the transfusion. –Improved sucking and volume ingested by premature infants who were poor feeders prior to the transfusion. –Enhanced average daily weight gain in all premature infants. Copyright restrictions may apply

10. Comment Poor feeding and failure to gain weight may be considered as adjuncts to hematological parameters in the decision-making process as to whether to transfuse premature infants for AOP. Prospective data should be obtained to evaluate this hypothesis. Copyright restrictions may apply

11. If you have questions, please contact the corresponding author: –Ruben Bromiker, MD, Department of Neonatology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem, Israel (bromi@szmc.org.il). Copyright restrictions may apply Contact Information