Platelet Transfusion and Death or Neurodevelopmental Impairment in Children Born Extremely Preterm.
Platelet Transfusion and Death or Neurodevelopmental Impairment in Children Born Extremely Preterm.
复制标题
血小板输血，死亡或神经发育障碍，出生于早产。
DOI：
10.1001/jamanetworkopen.2023.52394
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发表时间：
2024-01-02
影响因子：
13.8
通讯作者：
Patel RM
中科院分区：
文献类型：
--
作者：
Davenport PE;Wood TR;Heagerty PJ;Sola-Visner MC;Juul SE;Patel RM
血小板输注是否与极早产儿的死亡或神经发育障碍有关？在这项纳入819名极早产婴儿的队列研究中，与未接触血小板的婴儿相比，接触血小板输注的婴儿在2岁校正年龄时死亡或严重神经发育障碍的发生率在统计学上显著更高（46.5% vs 13.9%）。在单独的分析中，死亡和重度NDI与总体复合结局在方向上一致。这项研究的结果表明，接受血小板输注的极早产儿可能有更高的死亡或神经发育障碍风险。由于担心颅内出血，极早产婴儿接受的输血血小板计数阈值高于年龄较大的儿童和成人。最近一项比较2种血小板输注阈值的随机试验显示，较高的阈值与长期不良神经发育结局的风险增加相关。评价极早产儿队列中血小板输注暴露与2岁校正年龄时死亡和严重神经发育障碍（NDI）的相关性。早产促红细胞生成素神经保护试验的观察性队列研究和次要分析，是一项在极早产新生儿中进行的促红细胞生成素神经保护的随机、安慰剂对照临床试验，于2013年12月1日至2016年9月31日在美国30个新生儿重症监护室进行。这项分析包括819名在妊娠24至27周时出生的极早产婴儿，他们有记录的结局（死亡或神经发育评估）。分析于二零二三年四月进行。新生儿重症监护病房住院期间输注任何血小板。主要复合终点是使用贝利婴儿发育量表第三版（BSID-III）和粗大运动功能分类系统在2岁校正年龄时评估的死亡或重度NDI，并定义为重度脑瘫或BSID-III复合运动或认知评分低于平均值2 SD。血小板输注适应症的混杂因素采用协变量调整和倾向评分法进行处理。在纳入分析的819名婴儿中（429名[52.4%]男性;平均[SD]胎龄，25.5 [1.1]周），245名（30.0%）在首次住院期间接受了至少1次血小板输注。主要结局发生在46.5%（114/245）的暴露于血小板输注的婴儿和13.9%（80/574）的未暴露的婴儿中，相应的比值比为2.43（95%CI，1.24-4.76），调整了倾向评分、出生时胎龄和试验治疗组。死亡和重度NDI的各个组成部分与总体复合结局在方向上一致。本研究的结果表明，极早产儿输注血小板可能与2岁校正年龄时死亡或重度NDI风险增加相关，尽管不能排除适应症的残余混杂可能性。本队列研究检测了接受血小板输注的极早产儿在2岁校正年龄时死亡或严重神经发育障碍的存在。
Are platelet transfusions associated with death or neurodevelopmental impairment in children born extremely preterm? In this cohort study of 819 infants born extremely preterm enrolled in a clinical trial of erythropoietin neuroprotection, infants exposed to platelet transfusion had a statistically significant higher incidence of death or severe neurodevelopmental impairment at 2 years’ corrected age compared with nonexposed infants (46.5% vs 13.9%). In separate analyses, death and severe NDI were directionally consistent with the overall composite outcome. The findings of this study suggest that infants born extremely preterm who receive platelet transfusions may have a higher risk of death or neurodevelopmental impairment. Infants born extremely preterm receive transfusions at higher platelet count thresholds than older children and adults due to concerns for intracranial hemorrhage. A recent randomized trial comparing 2 platelet transfusion thresholds showed the higher threshold was associated with increased risk of long-term adverse neurodevelopmental outcomes. To evaluate the association of platelet transfusion exposure with death and severe neurodevelopmental impairment (NDI) at 2 years’ corrected age in a cohort of infants born extremely preterm. An observational cohort study and secondary analysis of the Preterm Erythropoietin Neuroprotection Trial, a randomized, placebo-controlled clinical trial of erythropoietin neuroprotection in neonates born extremely preterm, was conducted in 30 neonatal intensive care units in the US from December 1, 2013, to September 31, 2016. This analysis included 819 infants born extremely preterm at 24 to 27 completed weeks of gestation who had a documented outcome (death or neurodevelopmental assessment). Analysis was performed in April 2023. Any platelet transfusion during neonatal intensive care unit hospitalization. The primary composite outcome was death or severe NDI evaluated at 2 years’ corrected age using the Bayley Scales of Infant Development–Third Edition (BSID-III) and the Gross Motor Function Classification System and was defined as the presence of severe cerebral palsy or a BSID-III composite motor or cognitive score 2 SDs below the mean. Confounding by indication for platelet transfusion was addressed with covariate adjustment and propensity score methods. Of the 819 infants included in the analysis (429 [52.4%] male; mean [SD] gestational age, 25.5 [1.1] weeks), 245 (30.0%) received at least 1 platelet transfusion during their initial hospitalization. The primary outcome occurred in 46.5% (114 of 245) of infants exposed to a platelet transfusion and 13.9% (80 of 574) of nonexposed infants with a corresponding odds ratio of 2.43 (95% CI, 1.24-4.76), adjusted for propensity score, gestational age at birth, and trial treatment group. The individual components of death and severe NDI were directionally consistent with the overall composite outcome. The findings of this study suggest that platelet transfusion in infants born extremely preterm may be associated with an increased risk of death or severe NDI at 2 years’ corrected age, although the possibility of residual confounding by indication cannot be excluded. This cohort study examines the presence of death or severe neurodevelopmental impairment at 2 years’ corrected age in infants born extremely preterm who received platelet transfusions.
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