Teofili Luciana, Papacci Patrizia, Bartolo Martina, Molisso Anna, Orlando Nicoletta, Pane Lucia, Giannantonio Carmen, Serrao Francesca, Bianchi Maria, Valentini Caterina Giovanna, Pellegrino Claudio, Baldascino Antonio, Carducci Brigida, Lepore Domenico, Vento Giovanni
Divisione di Medicina Trasfusionale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy.
Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
Front Pediatr. 2022 Feb 10;10:814194. doi: 10.3389/fped.2022.814194. eCollection 2022.
Repeated red blood cell (RBC) transfusions are thought to increase the risk for retinopathy of prematurity (ROP), likely due to a critical fetal hemoglobin (HbF) reduction. In this study, we investigated if the postmenstrual age (PMA) of neonates at transfusion influences the risk for ROP. We estimated the cumulative transfusion-free survival (TFS) in a series of 100 preterm neonates receiving one or more RBC units. TFS was calculated by censoring patients at first transfusion and expressing the time between birth and transfusion as either PMA or postnatal day. Then, we investigated if TFS predicted the occurrence of severe ROP, defined as ROP stage 3 or higher. We found that neonates with severe ROP displayed a significantly shorter TFS expressed according to their PMA ( = 0.001), with similar TFS according to postnatal days. At receiver operating characteristic (ROC) curve analysis, receiving an RBC unit before week 28 of PMA predicted severe ROP with a sensitivity of 64% and a specificity of 78%. In addition, receiving a second RBC unit before the PMA of 29 weeks predicted severe ROP with a sensitivity of 75% and a specificity of 69%. At multivariate analysis, PMA at the second transfusion was even more informative than at first transfusion and outperformed all other variables in predicting severe ROP, with an odds ratio of 4.554 (95% CI 1.332-15.573, = 0.016). Since HbF decrease is greater after multiple RBC transfusions, it is conceivable that neonates receiving more than one unit before the PMA of 29 weeks may be exposed to a greater disturbance of retinal vascularization. Any strategy aimed at preventing the critical HbF decrease at this low age might potentially reduce the risk for severe ROP.
反复输注红细胞（RBC）被认为会增加早产儿视网膜病变（ROP）的风险，这可能是由于胎儿血红蛋白（HbF）显著降低所致。在本研究中，我们调查了输血时新生儿的月经后年龄（PMA）是否会影响ROP的风险。我们估计了100例接受一个或多个RBC单位输注的早产儿的累计无输血生存期（TFS）。TFS通过在首次输血时对患者进行截尾来计算，并将出生至输血之间的时间表示为PMA或出生后天数。然后，我们调查了TFS是否能预测严重ROP的发生，严重ROP定义为3期或更高分期的ROP。我们发现，患有严重ROP的新生儿根据其PMA表示的TFS显著缩短（P = 0.001），根据出生后天数表示的TFS相似。在受试者工作特征（ROC）曲线分析中，在PMA第28周之前接受一个RBC单位预测严重ROP的敏感性为64%，特异性为78%。此外，在PMA第29周之前接受第二个RBC单位预测严重ROP的敏感性为75%，特异性为69%。在多变量分析中，第二次输血时的PMA在预测严重ROP方面比第一次输血时更具信息量，并且优于所有其他变量，优势比为4.554（95%CI 1.332 - 15.573，P = 0.016）。由于多次RBC输血后HbF下降更大，可以想象，在PMA第29周之前接受多个单位输血的新生儿可能会受到视网膜血管化更大的干扰。任何旨在防止在这个低年龄时HbF关键下降的策略都可能潜在地降低严重ROP的风险。
