新生儿和婴儿围手术期红细胞输血：麻醉实践在欧洲的新生儿和儿童中的评估：一项前瞻性的欧洲多中心观察性研究。

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study.

机构信息

From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (AF, TR), Unit for Research & Innovation in Anaesthesia, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy (ND, TR), Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, University of Geneva, Geneva (KV, WH), Department of Paediatrics, Section of Critical Care, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (FU), and Department of Anaesthesiology, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands (JCdG).

出版信息

Eur J Anaesthesiol. 2022 Mar 1;39(3):252-260. doi: 10.1097/EJA.0000000000001646.

DOI:10.1097/EJA.0000000000001646

PMID:34845167

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8815837/

Abstract

BACKGROUND

Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards.

OBJECTIVE

To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome.

DESIGN

A multicentre observational study.

SETTING

The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017.

PATIENTS

The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion.

MAIN OUTCOME MEASURES

The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality.

RESULTS

Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%.

CONCLUSIONS

Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies.

TRIAL REGISTRATION

ClinicalTrials.gov, identifier: NCT02350348.

摘要

背景

目前对于新生儿和小婴儿围手术期输红细胞的临床实践知之甚少。指南建议根据血红蛋白阈值（8.5 至 12 g/dl）进行输血，区分出生至第 7 天（第 1 周）、第 8 天至第 14 天（第 2 周）或第 15 天（≥第 3 周）的儿童。

目的

观察根据指南进行围手术期输红细胞治疗与患者结局的相关性。

设计

多中心观察性研究。

地点

欧洲新生儿-儿童麻醉实践研究（NECTARINE）试验于 2016 年 3 月至 2017 年 1 月期间在 31 个欧洲国家的 165 个中心招募了 60 周龄前接受手术或诊断程序麻醉的患者。

患者

该数据包括 5609 名接受 6542 例手术的患者。纳入标准为围手术期输红细胞。

主要观察指标

主要终点为第 1、2 和 3 周新生儿触发输血的血红蛋白水平。次要终点为输血量、“血红蛋白差值”（术前-输血触发）以及 30 天和 90 天的发病率和死亡率。

结果

447 例（6.9%）记录了围手术期输红细胞。第 1 周新生儿触发输血的血红蛋白中位数为 9.6 [IQR 8.7 至 10.9] g/dl，第 2 周为 9.6 [7.7 至 10.4] g/dl，第 3 周为 8.0 [7.3 至 9.0] g/dl。输血中位数为 17.1 [11.1 至 26.4] ml/kg，血红蛋白差值中位数为 1.8 [0.0 至 3.6] g/dl。30 天发病率为 47.8%，总死亡率为 11.3%。