Patel Ravi Mangal, Meyer Erin K, Widness John A
Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
Departments of Pathology and Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH.
Transfus Med Rev. 2016 Oct;30(4):165-73. doi: 10.1016/j.tmrv.2016.06.005. Epub 2016 Jul 4.
Red blood cell (RBC) transfusion is a common and lifesaving therapy for anemic neonates and infants, particularly among those born prematurely or undergoing surgery. However, evidence-based indications for when to administer RBCs and adverse effects of RBC transfusion on important outcomes including necrotizing enterocolitis, survival, and long-term neurodevelopmental impairment remain uncertain. In addition, blood-banking practices for preterm and term neonates and infants have been largely developed using studies from older children and adults. Use of and refinements in emerging technologies and advances in biomarker discovery and neonatal-specific RBC transfusion databases may allow clinicians to better define and tailor RBC transfusion needs and practices to individual neonates. Decreasing the need for RBC transfusion and developing neonatal-specific approaches in the preparation of donor RBCs have potential for reducing resource utilization and cost, improving outcomes, and assuring blood safety. Finally, large donor-recipient-linked cohort studies can provide data to better understand the balance of the risks and benefits of RBC transfusion in neonates. These studies may also guide the translation of new research into best practices that can rapidly be integrated into routine care. This review highlights key opportunities in transfusion medicine and neonatology for improving the preparation and transfusion of RBCs into neonates and infants. We focus on timely, currently addressable knowledge gaps that can increase the safety and efficacy of preterm and term neonatal and infant RBC transfusion practices.
红细胞（RBC）输血是治疗贫血新生儿和婴儿的常见且挽救生命的疗法，尤其是对于那些早产或接受手术的患儿。然而，关于何时输注红细胞的循证指征以及红细胞输血对包括坏死性小肠结肠炎、生存率和长期神经发育障碍等重要结局的不良影响仍不明确。此外，早产和足月新生儿及婴儿的血库操作很大程度上是基于对大龄儿童和成人的研究而发展起来的。新兴技术的应用和改进以及生物标志物发现和新生儿特异性红细胞输血数据库的进展，可能使临床医生能够更好地界定并根据个体新生儿的情况调整红细胞输血需求和操作。减少红细胞输血需求并开发针对新生儿的供体红细胞制备方法，有可能降低资源利用和成本、改善结局并确保血液安全。最后，大型供体 - 受者关联队列研究可以提供数据，以更好地了解新生儿红细胞输血的风险和益处的平衡。这些研究还可能指导将新研究转化为可迅速纳入常规护理的最佳实践。本综述强调了输血医学和新生儿学中在改善向新生儿和婴儿输注红细胞的制备和输血方面的关键机遇。我们关注能够提高早产和足月新生儿及婴儿红细胞输血操作安全性和有效性的及时且当前可解决的知识空白。
