Transfusion in neonates and older children: Principles and updates
Transfusion in neonates and older children: Principles and updates
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DOI：
10.1016/j.tracli.2019.07.003
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发表时间：
2019-09-01
影响因子：
1.7
通讯作者：
New, H., V
中科院分区：
文献类型：
--
作者：
New, H., V
新生儿和年龄较大的儿童的输血遵循与成人类似的原则。在许多领域，缺乏与年龄相适应的证据基础，从成人研究和实践中推断出共识指导，但已经有几个关键的儿科随机对照试验(RCT)。患者血液管理是基于证据的方法，以优化可能需要输血的患者的护理，从而减少输血需求。尽管迄今为止许多国家的重点主要放在成人身上，但PBM的原则可能同样适用于新生儿和儿童[1，2]。具体的例子包括使用延迟的脐带夹[3-5]和小样品管和实验室分析器，以减少对新生儿补充输血的要求。至于成人，有证据表明，新生儿[6]和年龄较大的儿童[7]的术前贫血与较差的术后结果有关，这表明诊断和纠正术前缺铁的措施也可能是有益的，这些缺铁通常发生在儿科年龄组[8]。
Transfusions for neonates and older children follow similar principles as in adults. In many areas the age-appropriate evidence base is lacking, with consensus guidance extrapolated from adult studies and practice, but there have been several key paediatric randomised controlled trials (RCTs).‘Patient Blood Management’is the evidence-based approach to optimising the care of patients who might need transfusion thereby reducing transfusion requirements. Although the focus in many countries to date has been largely on adults, the principles of PBM are likely to be equally appropriate for neonates and children [1, 2]. Specific examples include the use of delayed cord clamping [3–5] a nd of small sample tubes and laboratory analysers to reduce the requirement for neonatal top-up transfusions. As for adults, there is evidence that pre-operative anaemia in neonates [6] and older children [7], is associated with worse post-operative outcomes, suggesting that measures to diagnose and correct pre-operative iron deficiency, commonly occurring in the paediatric age group [8], may also be beneficial.