Among very-low-birth-weight neonates is red blood cell transfusion an independent risk factor for subsequently developing a severe intraventricular hemorrhage?
Among very-low-birth-weight neonates is red blood cell transfusion an independent risk factor for subsequently developing a severe intraventricular hemorrhage?
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DOI：
10.1111/j.1537-2995.2010.02980.x
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发表时间：
2011-06-01
期刊：
影响因子：
2.9
通讯作者：
Christensen, Robert D.
中科院分区：
文献类型：
--
作者：
Baer, Vickie L.;Lambert, Diane K.;Christensen, Robert D.
背景：早产儿严重脑室内出血（IVH）可导致终身残疾或死亡。IVH的发病机制尚未完全阐明。我们假设，如果严重IVH的时间可以近似串行超声，可能相关的前因可以identified.Study设计和方法：我们回顾性地确定了所有极低出生体重（VLBW）的新生儿在我们的卫生系统，在5年的时间内，与最初的头部超声显示没有出血，但随后的超声显示3级或4级。对照组没有发展IVH匹配的情况下，使用人口统计学特征和疾病程度measurement.RESULTS：54例匹配（1：2）与对照组。病例组和对照组在初始pH值、败血症、通气、凝血研究或重度血小板减少的比例方面无差异。然而，在头部超声正常的时期，病例更可能有红细胞（RBC）输注（p < 0.001）。在94%的病例中，顺序为1）无IVH，2）RBC输注，3）重度IVH。使用逻辑回归分析，第一周内每次后续红细胞输注均使严重IVH的风险增加一倍（每次输注增加相对风险，2.02; 95%置信区间，1.54-3.33）。敏感性分析表明，红细胞输注，独立于血红蛋白水平或其他因素，增加发展严重IVH.CONCLUSION的风险的可能性很高：这些研究结果提出了一个新的假设。也就是说，在IVH发展之前给予RBC输注是发展严重IVH的独立风险因素。
BACKGROUND: A severe intraventricular hemorrhage (IVH) in a preterm neonate can result in life-long disabilities or death. Pathogenic mechanisms responsible for IVH are incompletely understood. We postulated that if the timing of a severe IVH could be approximated by serial ultrasound, potentially relevant antecedents could be identified.STUDY DESIGN AND METHODS: We retrospectively identified all very-low-birth-weight (VLBW) neonates in our health system, over a 5-year period, with an initial head ultrasound showing no hemorrhage but a subsequent ultrasound showing a Grade 3 or 4. Controls that did not develop an IVH were matched with cases using demographic features and degree of illness measures.RESULTS: Fifty-four cases were matched (1: 2) with controls. No differences were found between cases and controls in initial pH, sepsis, ventilation, coagulation studies, or proportion with severe thrombocytopenia. However, during the period when the head ultrasound was normal, cases were more likely to have had a red blood cell (RBC) transfusion (p < 0.001). In 94% of the cases the sequence was 1) no IVH, 2) RBC transfusion, and 3) severe IVH. With the use of logistic regression, each subsequent RBC transfusion during the first week was determined to double the risk of a severe IVH (each transfusion increases relative risk, 2.02; 95% confidence interval, 1.54-3.33). Sensitivity analysis indicated a high likelihood that RBC transfusion, independent of hemoglobin level or other factors, increases the risk of developing a severe IVH.CONCLUSION: These findings suggest a new hypothesis. Namely, RBC transfusions given before the development of an IVH are an independent risk factor for developing a severe IVH.