肯尼亚基利菲区医院收治的儿童和新生儿输血变化趋势。

Changing trends in blood transfusion in children and neonates admitted in Kilifi District Hospital, Kenya.

机构信息

Kenya Medical Research Institute-Wellcome Trust Programme, PO Box 230, Kilifi, Kenya.

出版信息

Malar J. 2010 Oct 30;9:307. doi: 10.1186/1475-2875-9-307.

DOI:10.1186/1475-2875-9-307

PMID:21034494

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2991344/

Abstract

BACKGROUND

Severe anaemia is a common cause for hospitalization in children in sub-Saharan Africa. Malaria plays an important aetiological role, resulting in a substantial burden of paediatric transfusion in hospitals. A decline in malaria and paediatric admissions to the Kilifi District Hospital has been reported recently. This study aimed to investigate whether this trend affected clinical burden, clinical severity of anaemia and requirements for paediatric transfusion.

METHODS

Eight-year retrospective review of paediatric admissions to Kilifi District Hospital, Kenya describing the frequency of moderate and severe anaemia, blood transfusion and case fatality over time. Definitions for severe anaemia were Hb <8 g/dl for newborns and <5 g/dl for other age groups and for moderate anaemia was Hb 8 to <11 g/dl for newborns and 5 to <9.3 g/dl for other age groups. Life threatening anaemia was defined as severe anaemia (Hb <5 g/dl) complicated by either deep breathing or prostration or profound anaemia (Hb <4 g/dl) alone.

RESULTS

Of the 35,139 admissions 13,037 (37%) had moderate anaemia and 2,265 (6%) had severe anaemia; respiratory distress complicated 35% of cases with Hb <5 g/dl. Concurrent with the decline in malaria there was a marked decline in the prevalence of severe anaemia between 2002 (8%) and 2009 (< 4%) (chi2 for trend = 134, P < 0.0001). The number and proportion of admissions transfused also declined significantly over this time (chi2 for trend = 152, P < 0.0001). Of the 2,265 children with severe anaemia 191 (8%) died. Case fatality remained unchanged during this period (P < 0.26) and was largely explained by the unchanged proportion with life-threatening anaemia, present in 58-65% of cases throughout the study period.

CONCLUSION

The impact of reduced malaria transmission on child morbidity has positive public benefits on the demand and use of blood for paediatric transfusion. Despite an overall reduction in paediatric transfusion requirement, case fatality of severe anaemia remained unchanged over this decade. Further research is required to improve outcome from severe anaemia, particularly in the high-risk group with life threatening features.

摘要

背景

在撒哈拉以南非洲地区，严重贫血是儿童住院的常见原因。疟疾在病因学中起着重要作用，导致医院儿科输血负担沉重。最近有报道称，疟疾和儿童入院人数有所下降。本研究旨在探讨这一趋势是否影响临床负担、贫血的临床严重程度以及儿科输血的需求。

方法

对肯尼亚基利菲区医院的 8 年儿科住院患者进行回顾性研究，描述了不同时间点中度和重度贫血、输血和病死率的发生频率。新生儿严重贫血的定义为 Hb <8 g/dl，其他年龄组为 Hb <5 g/dl；中度贫血的定义为新生儿 Hb 8 至<11 g/dl，其他年龄组为 5 至<9.3 g/dl。有生命危险的贫血定义为严重贫血（Hb <5 g/dl）伴有深呼吸或虚弱或单纯严重贫血（Hb <4 g/dl）。

结果

在 35139 例住院患者中，13037 例（37%）有中度贫血，2265 例（6%）有严重贫血；35%的 Hb <5 g/dl 病例伴有呼吸窘迫。随着疟疾的减少，2002 年（8%）和 2009 年（<4%）之间严重贫血的患病率明显下降（趋势 chi2 = 134，P < 0.0001）。在此期间，需要输血的住院人数和比例也显著下降（趋势 chi2 = 152，P < 0.0001）。在 2265 例严重贫血的儿童中，191 例（8%）死亡。在此期间病死率保持不变（P < 0.26），这主要是由于有生命危险的贫血比例不变，在整个研究期间，该比例占病例的 58-65%。