Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g
Changing practices of red blood cell transfusions in infants with birth weights less than 1000 g
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DOI：
10.1016/s0022-3476(00)70105-3
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发表时间：
2000-02-01
影响因子：
5.1
通讯作者：
Obladen, M
中科院分区：
文献类型：
--
作者：
Maier, RF;Sonntag, J;Obladen, M
目的：极低出生体重（ELBW）婴儿经常接受输血，因为他们病情危重，经常需要人工通气，并且与其体重相关的血液采样损失最高。在过去十年中，我们的输血指南已更改 3 次，变得更加严格。我们假设这些修改大大减少了 ELBW 婴儿的输血次数。方法：我们对 1989 年至 1997 年入院的 256 名出生体重为 500 至 999 g 的婴儿进行了单中心分析，包括 3 个研究期，每个研究期均从 1989 年 4 月、1991 年 9 月和 1995 年 1 月新修订的输血指南开始。结果：每个婴儿的中位输血次数从第一期的 7 次减少到第三期的 2 次，而供体暴露量从 5 次减少到 1 次，输血量从 131 mL/kg 出生体重减少到 37 mL/kg 出生体重（P < .01）。接受通气的婴儿在输血前测量的中位静脉血细胞比容从 43% 下降至 35%，而自主呼吸婴儿则从 41% 下降至 31%。中位出生体重从 870 克降至 740 克，中位孕龄从 27 周降至 25 周 (P < .01)。总生存率为75%，没有变化。视网膜病变、脑室内出血和动脉导管未闭的发生率保持不变。结论：在输血指南日益严格的这9年期间，ELBW婴儿的输血次数减少了71%，供体暴露量减少了80%，且没有不良临床影响。
Objective: Extremely low birth weight (ELBW) infants frequently undergo transfusion because they are critically ill, often need artificial ventilation, and have the highest blood sampling loss in relation to their weight. During the last decade our transfusion guidelines were changed 3 times to become more restrictive. We hypothesized that these modifications substantially decreased the number of transfusions in our ELBW infants.Methods: We performed a single-center analysis of 256 infants with birth weights from 500 to 999 g who were admitted from 1989 to 1997 and included 3 study periods, each starting with newly modified transfusion guidelines in April 1989, September 1991, and January 1995. We evaluated prospectively recorded clinical data and retrospective chart analysis for transfusion-related information.Results: The median number of transfusions per infant decreased from 7 in the first period to 2 in the third period, whereas donor exposure decreased from 5 to 1 and blood volume transfused decreased from 131 to 37 mL/kg birth weight (P < .01). The median venous hematocrit measured before transfusion decreased from 43% to 35% in infants who underwent ventilation and from 41% to 31% in spontaneously breathing infants. The median birth weight decreased fr om 870 to 740 g and the median gestational age from 27 to 25 completed weeks (P < .01). The overall survival rate was 75% and did not change. The incidences of retinopathy, intraventricular hemorrhage, and patent ductus arteriosus remained unchanged.Conclusion: Over this 9-year period with increasingly restrictive transfusion guidelines, the transfusion number decreased by 71% and the donor exposure by 80% in ELBW infants without adverse clinical effects.