Analysis of risk factors associated with red blood cell transfusion in very low birth weight infants
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摘要: 目的确立极低出生体重儿红细胞输注的独立危险因素，并探讨独立危险因素数量与红细胞输注发生率之间的关系。方法对2020年6月至2021年3月在华中科技大学同济医学院附属武汉儿童医院住院治疗的出生体重≤1500 g的患儿进行回顾性分析，根据有无红细胞输注，将患儿分为输血组和非输血组。比较2组的临床资料、检查结果、临床并发症和住院期间的治疗措施，以确定红细胞输注的危险因素，并分析极低出生体重儿输血危险因素数量与红细胞输注发生率的关系。结果70例极低出生体重儿中，44例接受红细胞输注，输注率为62.9%，输血组与非输血组比较，患儿的出生体重、住院身长、住院天数、妊娠天数、妊娠并发症总数以及5 min Apgar评分＜7分、机械通气、肺出血、支气管肺发育不良、脓毒血症、颅内出血、住院天数>40 d的例数差异有统计学意义，多因素二元logistic回归分析表明，机械通气、5 min Apgar评分＜7分和妊娠并发症是极低出生体重儿红细胞输注的独立临床预测因素，极低出生体重儿输血危险因素数量与红细胞输注发生率的关系呈正相关。结论新生儿成熟度和临床严重程度相关的临床特征与极低出生体重儿红细胞输注显著相关，随着极低出生体重儿危险因素数量的增加，输注红细胞的可能性增加。Abstract: ObjectiveTo determine independent risk factors of red blood cell(RBC) transfusion in very low birth weight(VLBW) infants and explore the association between the number of RBC transfusion risk factors in VLBW infants with morbidity of RBC transfusion.MethodsVLBW infants with birth weight ≤1500 g admitted to our hospital from June 2020 to March 2021 were retrospectively analyzed, the infants were divided into the blood transfusion group and the non-blood transfusion group according to RBC transfusion status. The clinical data, examination results, clinical complications and treatment measures during hospitalization were compared between the two groups to determine risk factors of RBC transfusion, and then, the association between the number of RBC transfusion risk factors in VLBW infants with morbidity of RBC transfusion were analyzed.ResultsOf 70 VLBW infants enrolled, 44 received RBC transfusion with the RBC transfusion rate of 62.9%, compared with VLBW infants in non-transfusion group, the general data of birth weight, height in hospitalization, hospitalization day, gestational day, the total number of pregnancy complications, Apgar score at 5 minutes < 7, mechanical ventilation, pulmonary hemorrhage, BPD, sepsis, IVH, hospitalization day>40 days had significant difference in VLBW infants in transfusion group, multivariate binary logistic regression analysis showed that mechanical ventilation, Apgar score at 5 minute < 7 and pregnancy complications were independent clinical predictors for RBC transfusion in VLBW infants and there was a positive relationship between morbidity of RBC transfusion and the number of RBC transfusion risk factors in VLBW infants.ConclusionThe clinical characteristics related to neonatal maturity and clinical severity were significantly associated with the indication for RBC transfusion in VLBW infants and the possibility of RBC transfusion increased with the increase of the number of risk factors in VLBW infants.
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表 1 极低出生体重儿红细胞输注的血红蛋白水平阈值
g/L 日龄 标本类型 呼吸支持 无呼吸支持 1~7 d 毛细血管采血 ≤115 ≤100 大血管采血 ≤104 ≤90 8~14 d 毛细血管采血 ≤100 ≤85 大血管采血 ≤90 ≤77 ≥15 d 毛细血管采血 ≤85 ≤75 大血管采血 ≤77 ≤68 
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表 2 输血组和非输血组患儿基本情况
项目 总例数 输血组 非输血组 P 出生体重/g 1 268.71±187.52 1 221.82±197.06 1 348.08±140.86 0.006 住院身长/cm 40.74±5.67 38.81±2.76 44.00±7.61 ＜0.001 住院天数/d 43.00±22.09 52.68±21.11 26.62±11.68 ＜0.001 怀孕天数/d 211.44±14.45 208.90±13.73 216.62±14.43 0.020 1 min Apgar评分/分 7.0(5.0，8.0) 7.0(5.0，8.0) 7.0(5.75，8.0) 0.134 5 min Apgar评分/分 8.0(7.0，9.0) 8.0(6.0，9.0) 8.0(7.75，9.0) 0.199 性别(男/女)/例 35/35 22/22 13/13 1.000 居住地址(城市/农村)/例 37/33 24/20 13/13 0.713 生产方式(剖宫产/顺产)/例 44/26 26/18 18/8 0.396 怀孕胎数(单胎/双胎)/例 52/18 31/13 21/5 0.340 怀孕方式(自然/人工辅助)/例 62/8 37/7 25/1 0.125 孕产史(是/否)/例 39/31 24/20 15/11 0.798 妊娠并发症(是/否)/例 35/35 27/17 8/18 0.013 小于胎龄儿(是/否)/例 24/46 17/27 7/19 0.318 1 min Apgar评分＜7(是/否)/例 28/42 21/23 7/19 0.137 5 min Apgar评分＜7(是/否)/例 21/49 18/26 3/23 0.010 呼吸暂停(是/否)/例 34/36 24/20 10/16 0.193 机械通气(是/否)/例 53/17 41/3 12/14 ＜0.001 肺出血(是/否)/例 6/64 6/38 0/26 0.049 肺支气管发育不良(是/否)/例 40/30 30/14 10/16 0.015 脓毒血症(是/否)/例 11/59 10/34 1/25 0.036 新生儿小肠结肠炎(是/否)/例 11/59 8/36 3/23 0.461 颅内出血(是/否)/例 22/48 20/24 2/24 0.001 肠外营养(是/否)/例 65/5 41/3 24/2 0.891 住院天数＞40 d(是/否)/例 35/35 30/14 5/21 0.001
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表 3 极低出生体重儿红细胞输注预测因子的单因素及多因素二元logistic回归分析
项目 单因素分析 多因素分析 P OR 95%CI P OR 95%CI 出生体重 0.010 1.005 1.001~1.008 住院身长 ＜0.001 1.432 1.177~1.741 怀孕天数 0.026 1.042 1.005~1.081 住院时间 ＜0.001 0.903 0.859~0.949 妊娠并发症 0.015 0.280 0.100~0.784 0.044 0.262 0.069~1.000 5 min Apgar评分＜7分 0.015 0.188 0.049~0.723 0.025 0.162 0.033~0.793 机械通气 ＜0.001 0.063 0.015~0.255 0.013 0.136 0.028~0.653 住院天数＞40 d ＜0.001 0.111 0.035~0.356
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[1] 高琦, 蒋海燕, 刘利军. 极低/超低出生体重儿高危因素分析研究现状[J]. 包头医学院学报, 2019, 35(9): 125-127, 130. https://www.cnki.com.cn/Article/CJFDTOTAL-BTYX201909053.htm
[2] Horbar JD, Carpenter JH, Badger GJ, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009[J]. Pediatrics, 2012, 129(6): 1019-1026. doi: 10.1542/peds.2011-3028
[3] Lee HC, Liu J, Profit J, et al. Survival Without Major Morbidity Among Very Low Birth Weight Infants in California[J]. Pediatrics, 2020, 146(1): e20193865. doi: 10.1542/peds.2019-3865
[4] 付晶, 刘芳. 早产儿支气管肺发育不良研究进展[J]. 临床误诊误治, 2018, 31(3): 107-111. doi: 10.3969/j.issn.1002-3429.2018.03.032
[5] 王晓珺. 极低出生体重儿贫血的研究进展[J]. 中国小儿血液与肿瘤杂志, 2017, 22(6): 331-334. doi: 10.3969/j.issn.1673-5323.2017.06.012
[6] Lopriore E. Updates in Red Blood Cell and Platelet Transfusions in Preterm Neonates[J]. Am J Perinatol, 2019, 36(S 02): S37-S40. doi: 10.1055/s-0039-1691775
[7] 彭华, 童笑梅. 医源性失血与早产儿贫血的发生及需要输血的相关性研究[J]. 中国新生儿科杂志, 2008, 23(4): 197-200.
[8] Ringer SA, Richardson DK, Sacher RA, et al. Variations in transfusion practice in neonatal intensive care[J]. Pediatrics, 1998, 101(2): 194-200. doi: 10.1542/peds.101.2.194
[9] Maier RF, Sonntag J, Walka MM, et al. Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g[J]. J Pediatr, 2000, 136(2): 220-224. doi: 10.1016/S0022-3476(00)70105-3
[10] 王星, 王雅茹, 李亭, 王晓卫, 李萌. 233例儿童非传染性输血不良反应相关因素分析[J]. 临床血液学杂志, 2021, 34(6): 399-402. http://lcxz.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=11d037f7-e5c5-418c-acb2-05f5c598ab93
[11] 何丽苇, 王顺, 陈会欣. 某三甲医院输血不良反应回顾性分析[J]. 临床血液学杂志, 2018, 31(12): 904-906. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201812004.htm
[12] 甘珊, 王佳, 段灵, 等. 儿童输血相关过敏性休克的临床病例分析[J]. 中国输血杂志, 2020, 33(12): 1264-1267. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202012018.htm
[13] Kirpalani H, Whyte RK, Andersen C, et al. The Premature Infants in Need of Transfusion(PINT)study: a randomized, controlled trial of a restrictive(low)versus liberal(high)transfusion threshold for extremely low birth weight infants[J]. J Pediatr, 2006, 149(3): 301-307. doi: 10.1016/j.jpeds.2006.05.011
[14] 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257.
[15] Dai L, Deng C, Li Y, et al. Population-based birth weight reference percentiles for Chinese twins[J]. Ann Med, 2017, 49(6): 470-478.
[16] 中华医学会儿科学分会新生儿学组. 新生儿肺出血的诊断与治疗方案[J]. 现代实用医学, 2003, 6(15): 395-395. https://www.cnki.com.cn/Article/CJFDTOTAL-NBYX200306046.htm
[17] Tan AP, Svrckova P, Cowan F, et al. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes[J]. Eur J Paediatr Neurol, 2018, 22(4): 690-717.
[18] Hasan SU, Potenziano J, Konduri GG, et al. Effect of Inhaled Nitric Oxide on Survival Without Bronchopulmonary Dysplasia in Preterm Infants: A Randomized Clinical Trial[J]. JAMA Pediatr, 2017, 171(11): 1081-1089.
[19] Lee EY, Kim SS, Park GY, et al. Effect of red blood cell transfusion on short-term outcomes in very low birth weight infants[J]. Clin Exp Pediatr, 2020, 63(2): 56-62.
[20] Keir AK, Yang J, Harrison A, et al. Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada[J]. Transfusion, 2015, 55(6): 1340-1346.
[21] Franz AR, Engel C, Bassler D, et al. Effects of Liberal vs Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants: The ETTNO Randomized Clinical Trial[J]. JAMA, 2020, 324(6): 560-570.
[22] 徐春彩, 朱佳骏, 朱以琳, 等. 极低出生体质量儿输血相关危险因素分析[J]. 临床儿科杂志, 2017, 35(9): 641-644. https://www.cnki.com.cn/Article/CJFDTOTAL-LCAK201709001.htm
[23] Liao Z, Zhao X, Rao H, et al. Analysis of correlative risk factors for blood transfusion therapy for extremely low birth weight infants and extreme preterm infants[J]. Am J Transl Res, 2021, 13(7): 8179-8185.
[24] dos Santos AM, Guinsburg R, de Almeida MF, et al. Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units[J]. BMC Pediatr, 2015, 15: 113.
[25] Lie KK, Grøholt EK, Eskild A. Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study[J]. BMJ, 2010, 341: c4990.
[26] Liu W, Liu Q, Liu W, et al. Maternal risk factors and pregnancy complications associated with low birth weight neonates in preterm birth[J]. J Obstet Gynaecol Res, 2021, 47(9): 3196-3202.
[27] Kovatis KZ, Di Fiore JM, Martin RJ, et al. Effect of Blood Transfusions on Intermittent Hypoxic Episodes in a Prospective Study of Very Low Birth Weight Infants[J]. J Pediatr, 2020, 222: 65-70.
[28] 极低出生体重儿宫外生长发育迟缓危险因素的多中心研究[J]. 中华儿科杂志, 2020, 58(8): 653-660.
[29] Nayeri F, Dalili H, Nili F, et al. Risk factors for neonatal mortality among very low birth weight neonates[J]. Acta Med Iran, 2013, 51(5): 297-302.
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