Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan, USA.
Neonatology. 2021;118(4):425-433. doi: 10.1159/000515900. Epub 2021 May 11.
Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding.
The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population.
A cross-sectional study that utilized National Inpatient Sample for the years 2000-2017 was conducted. All preterm infants delivered nationally with birth weight (BW) <1,500 g or gestational age <32 weeks were included. Analyses were repeated after stratifying the population into 2 BW subcategories <1,000 g and 1,000-1,499 g. Logistic regression analysis was performed to adjust for confounding variables.
The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in <1,000-g infants (aOR = 1.96, CI: 1.76-2.18, p < 0.001) and 1,000-1,499-g infants (aOR = 2.02, CI: 1.62-2.53, p < 0.001). Platelet transfusion increased over the years in infants with BW <1,000 g (p = 0.001) and in infants with BW 1,000-1,499 g (p < 0.001).
Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.
预防性血小板输注已被广泛应用于早产儿血小板减少症的管理中，以降低出血风险。
本研究旨在报告早产儿血小板减少症患者中血小板输注的流行率，并评估血小板输注与该人群死亡率和发病率的关系。
本研究采用 2000 年至 2017 年全国住院患者样本进行横断面研究。所有出生体重（BW）<1500 g 或胎龄<32 周的全国性早产儿均被纳入研究。将人群分为<1000 g 和 1000-1499 g 两个 BW 亚组后，重复了分析。使用逻辑回归分析调整混杂变量。
本研究共纳入 1780299 名婴儿；其中，22609 名（1.27%）被诊断为血小板减少症，5134 名（22.7%）接受了血小板输注。血小板输注与死亡率显著增加相关（24.8%比 13.8%）、早产儿视网膜病变（22.3%比 19.2%）、严重脑室出血（18.3%比 10.1%）、中位住院时间（51 天比 47 天）和住院费用（298204 美元比 219760 美元）。在<1000 g 婴儿（aOR = 1.96，CI：1.76-2.18，p < 0.001）和 1000-1499 g 婴儿（aOR = 2.02，CI：1.62-2.53，p < 0.001）中，死亡率增加。在 BW<1000 g 的婴儿（p = 0.001）和 BW 1000-1499 g 的婴儿（p < 0.001）中，血小板输注在研究期间呈上升趋势。
血小板输注与早产儿死亡率和并发症增加有关。在研究期间，血小板输注的使用呈上升趋势。
