Division of Neonatology, Clínica del Country, Bogota, DC, Colombia.
Universidad El Bosque, Bogota, Colombia.
J Perinatol. 2021 Jun;41(6):1403-1411. doi: 10.1038/s41372-021-00945-7. Epub 2021 Feb 10.
Red blood cell transfusions in infants born at ≤30 weeks gestation are frequent. Erythropoietin therapy reduces transfusions. An increase in hematocrit is an adaptive response at high altitudes but a guaranteed source of iron is necessary for adequate erythropoiesis.
A retrospective cohort study was done to compare red blood cell transfusion practices of the 2019 EpicLatino (EPIC) Latin America network database with a single unit at 2650 m above sea level (LOCAL). The data from LOCAL for three time periods were compared over 10 years based on changes in erythropoietin dose and fewer phlebotomies. The number of cases that received transfusions and the total number of transfusions required were compared. Adjustments were made for known risk factors using a multivariate regression analysis.
Two hundred and twenty-one cases in LOCAL and 382 cases from EPIC were included. Overall basic demographic characteristics were similar. In EPIC a significantly higher rate of infection (28% vs. 15%) and outborn (10% vs. 1%) was found, but less necrotizing enterocolitis (9% vs. 15%) and use of prenatal steroids (62% vs. 93%) than LOCAL (p < 0.05). EPIC patients received more transfusions (2.6 ± 3 vs. 0.6 ± 1 times) than LOCAL (p < 0.001) and received them significantly more frequently (61% vs. 25%). Within the LOCAL time periods, no statistically significant differences were found other than the need for transfusions (1st 32%, 2nd 28%, 3rd 9%, p = 0.005) and the average number of transfusions (1st 0.8 ± 1.6, 2nd 0.7 ± 1.3, 3rd 0.1 ± 0.3, p = 0.004). These differences remained significant after multivariate regression analysis and adjusting for risk variables.
The combination of erythropoietin, parenteral sucrose iron, fewer phlebotomies during the first 72 h, and delayed umbilical cord clamping seem to reduce red blood cell transfusion needs. This can be extremely important in high altitude units where higher hematocrit is desirable but may also be valuable at sea level.
在胎龄≤30 周的婴儿中，红细胞输注很常见。促红细胞生成素治疗可减少输血。在高海拔地区，血细胞比容升高是一种适应性反应，但为了充分的红细胞生成，需要有充足的铁来源。
我们对 2019 年 EpicLatino（EPIC）拉丁美洲网络数据库中的红细胞输注情况进行了回顾性队列研究，并与海拔 2650 米处的一个单位（LOCAL）进行了比较。根据促红细胞生成素剂量的变化和更少的采血次数，对 LOCAL 在 10 年内的三个时间段的数据进行了比较。比较了接受输血的病例数和所需的总输血次数。使用多变量回归分析对已知的风险因素进行了调整。
LOCAL 中有 221 例，EPIC 中有 382 例。总体基本人口统计学特征相似。在 EPIC 中，感染（28%比 15%）和外出分娩（10%比 1%）的发生率明显较高，但坏死性小肠结肠炎（9%比 15%）和产前使用类固醇（62%比 93%）的发生率较低（p<0.05）。EPIC 患者接受的输血次数（2.6±3 次比 0.6±1 次）明显多于 LOCAL（p<0.001），输血频率也明显更高（61%比 25%）。在 LOCAL 的时间周期内，除了输血的需要（第 1 组 32%，第 2 组 28%，第 3 组 9%，p=0.005）和平均输血次数（第 1 组 0.8±1.6，第 2 组 0.7±1.3，第 3 组 0.1±0.3，p=0.004）外，没有发现统计学上的显著差异。这些差异在多变量回归分析和调整风险变量后仍然显著。
促红细胞生成素、静脉注射蔗糖铁、在最初的 72 小时内减少采血次数，以及延迟脐带夹闭，似乎可以减少红细胞输注的需求。在高海拔地区，这种方法非常重要，因为高血细胞比容是理想的，但在海平面地区也可能有价值。
