Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Department of Pediatrics, Division of Neonatology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
J Perinatol. 2018 Aug;38(8):1022-1029. doi: 10.1038/s41372-018-0120-0. Epub 2018 May 8.
To determine the impact of progressive anemia of prematurity on cerebral regional saturation (C-rSO) in preterm infants and identify the hemoglobin threshold below which a critical decrease (>2SD below the mean) in C-rSO occurs.
In a cohort of infants born ≤30 weeks EGA, weekly C-rSO data were prospectively collected from the second week of life through 36 weeks post-menstrual age (PMA). Clinically obtained hemoglobin values were noted at the time of recording. Recordings were excluded if they were of insufficient duration (<1 h) or if the hemoglobin was not measured within 7 days. Statistical analysis was performed using a linear mixed effects-model and ROC analysis. ROC analysis was used to determine the threshold of anemia, where C-rSO critically decreased >2SD below the mean normative value (<55%) in preterm infants.
In total 253 recordings from 68 infants (mean EGA 26.9 ± 2.1 weeks, BW 1025 ± 287 g, 49% male) were included. Approximately 29 out of 68 infants (43%) were transfused during hospitalization. Mixed-model statistical analysis adjusting for EGA, BW, and PMA revealed a significant association between decreasing hemoglobin and C-rSO (p < 0.01) in transfusion-naive infants but not in transfused infants. In the transfusion naive group, using ROC analysis demonstrated a threshold hemoglobin of 9.5 g/dL (AUC 0.81, p < 0.01) for critical cerebral desaturation in preterm infants.
In transfusion-naive preterm infants, worsening anemia was associated with a progressive decrease in cerebral saturations. Analysis identified a threshold hemoglobin of 9.5 g/dL below which C-rSO dropped >2SD below the mean.
确定早产儿进行性贫血对早产儿脑区域性饱和度（C-rSO）的影响，并确定血红蛋白阈值，低于该阈值时 C-rSO 会出现临界下降（低于平均值 2 个标准差）。
在一个出生胎龄≤30 周的婴儿队列中，从生后第 2 周开始每周前瞻性地采集 C-rSO 数据，直至胎龄 36 周。在记录时记录临床获得的血红蛋白值。如果记录的持续时间不足（<1 小时）或血红蛋白未在 7 天内测量，则将记录排除在外。使用线性混合效应模型和 ROC 分析进行统计分析。ROC 分析用于确定贫血的阈值，即 C-rSO 在早产儿中临界下降超过平均值正常范围的 2 个标准差（<55%）。
总共纳入了 68 名婴儿的 253 次记录（平均胎龄 26.9±2.1 周，体重 1025±287 克，49%为男性）。住院期间约有 29 名婴儿（43%）接受了输血。调整胎龄、体重和胎龄后进行混合模型统计分析，发现未输血婴儿的血红蛋白下降与 C-rSO 呈显著相关（p<0.01），但在输血婴儿中无此相关性。在未输血组中，ROC 分析显示临界脑低氧的血红蛋白阈值为 9.5g/dL（AUC 0.81，p<0.01）。
在未输血的早产儿中，贫血恶化与脑饱和度的逐渐下降相关。分析确定了一个血红蛋白阈值，低于该阈值时 C-rSO 会下降超过平均值的 2 个标准差。
