Steiner Laurie A, Bizzarro Matthew J, Ehrenkranz Richard A, Gallagher Patrick G
Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064, USA.
Pediatrics. 2007 Jul;120(1):27-32. doi: 10.1542/peds.2006-2910.
Our goal was to identify trends in patient demographics and indications for and complications related to neonatal exchange transfusion over a 21-year period in a single institution using a uniform protocol for performing the procedure.
A retrospective chart review of 107 patients who underwent 141 single- or double-volume exchange transfusions from 1986-2006 was performed. Patients were stratified into 2 groups, 1986-1995 and 1996-2006, on the basis of changes in clinical practice influenced by American Academy of Pediatrics management guidelines for hyperbilirubinemia.
There was a marked decline in the frequency of exchange transfusions per 1000 newborn special care unit admissions over the 21-year study period. Patient demographics and indications for exchange transfusion were similar between groups. A significantly higher proportion of patients in the second time period received intravenous immunoglobulin before exchange transfusion. There was a higher proportion of patients in the 1996-2006 group with a serious underlying condition at the time of exchange transfusion. During that same time period, a lower proportion of patients experienced an adverse event related to the exchange transfusion. Although a similar percentage of patients in both groups experienced hypocalcemia and thrombocytopenia after exchange transfusion, patients treated from 1996-2006 were significantly more likely to receive calcium replacement or platelet transfusion. No deaths were related to exchange transfusion in either time period.
Improvements in prenatal and postnatal care have led to a sharp decline in the number of exchange transfusions performed. This decline has not led to an increase in complications despite relative inexperience with the procedure.
我们的目标是通过在单一机构中采用统一的操作方案，确定21年间新生儿换血治疗的患者人口统计学特征、适应证及相关并发症的变化趋势。
对1986年至2006年期间接受141次单倍量或双倍量换血治疗的107例患者进行回顾性病历审查。根据美国儿科学会高胆红素血症管理指南对临床实践的影响，将患者分为两组，即1986 - 1995年组和1996 - 2006年组。
在21年的研究期间，每1000例新生儿重症监护病房入院患者的换血治疗频率显著下降。两组间患者人口统计学特征及换血治疗适应证相似。在第二个时间段，显著更高比例的患者在换血治疗前接受了静脉注射免疫球蛋白。1996 - 2006年组中，换血治疗时合并严重基础疾病的患者比例更高。在同一时期，与换血治疗相关的不良事件发生比例较低。尽管两组中相似比例的患者在换血治疗后出现低钙血症和血小板减少症，但1996 - 2006年接受治疗的患者更有可能接受钙剂补充或血小板输注。两个时间段均无换血治疗相关死亡病例。
产前和产后护理的改善导致换血治疗次数大幅下降。尽管相对缺乏操作经验，但这种下降并未导致并发症增加。
