Division of Neonatology J6-S, Department of Pediatrics, Leiden University Medical Center, 2300RC Leiden, the Netherlands.
BMC Pediatr. 2011 May 28;11:48. doi: 10.1186/1471-2431-11-48.
In premature born infants red blood cell (RBC) transfusions have been associated with both beneficial and detrimental sequels. Upon RBC transfusion, improvement in cerebral blood flow and oxygenation have been observed, while a more liberal transfusion policy may be associated with a better developmental outcome. The effect of the transfusion volume on long-term outcome is not known.
Observational follow-up study of a cohort of extremely premature born infants, treated in 2 neonatal intensive care units using a different transfusion volume (15 ml/kg in Unit A and 20 ml/kg in Unit B). The primary outcome was a composite of post discharge mortality, neuromotor developmental delay, blindness or deafness, evaluated at a mean corrected age (CA) of 24 months related to the transfusion volume/kg bodyweight administered during the postnatal hospital stay.
Despite the difference in transfusion volume in clinically comparable groups of infants, they received a similar number of transfusions (5.5 ± 3.2 versus 5.5 ± 2.3 respectively in Unit A and B). The total transfused volume in unit A was 79 ± 47 ml/kg and 108 ± 47 ml/kg in unit B (p = 0.02). Total transfused RBC volume per kg bodyweight was not an independent predictor of the composite outcome (p = 0.96, OR 1.0 (CI 0.9-1.1).
There was no relationship between the composite outcome at 24 months CA and transfusion volume received during the post natal hospital stay. As there was no clinical advantage of the higher transfusion volume, a more restrictive volume will reduce total transfusion volume and donor exposure. Future research on the optimal transfusion volume per event to extreme preterm infants should include larger, prospective studies with a longer follow-up period through to childhood or even adolescence.
在早产儿中，输血与有益和有害的后果都有关联。在输血后，观察到脑血流和氧合的改善，而更宽松的输血策略可能与更好的发育结果相关。输血量对长期结果的影响尚不清楚。
对在 2 个新生儿重症监护病房接受治疗的极其早产儿队列进行观察性随访研究，使用不同的输血量（单位 A 为 15 ml/kg，单位 B 为 20 ml/kg）。主要结局是出院后死亡率、神经运动发育迟缓、失明或耳聋的复合结果，在平均校正年龄（CA）为 24 个月时进行评估，与住院期间输血后每公斤体重接受的输血体积/kg 相关。
尽管在临床可比的婴儿组中存在输血量的差异，但他们接受的输血次数相似（单位 A 为 5.5 ± 3.2，单位 B 为 5.5 ± 2.3）。单位 A 的总输血量为 79 ± 47 ml/kg，单位 B 的总输血量为 108 ± 47 ml/kg（p = 0.02）。每公斤体重接受的总输血量不是复合结局的独立预测因素（p = 0.96，OR 1.0（95%CI 0.9-1.1））。
在 24 个月 CA 时的复合结局与住院期间接受的输血量之间没有关系。由于较高输血量没有临床优势，因此更严格的体积限制将减少总输血量和供者暴露。未来对极早产儿每例事件的最佳输血量的研究应包括更大、前瞻性研究，随访时间更长，直至儿童期甚至青春期。
