Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Center for Medical Biochemistry, Max Perutz Labs, Medical University of Vienna, Vienna, Austria.
Lancet Haematol. 2022 Aug;9(8):e615-e626. doi: 10.1016/S2352-3026(22)00207-1.
Premature infants commonly receive adult packed red blood cells (pRBCs) during their hospital stay. As adult erythrocytes differ substantially from those of preterm infants, transfusion of adult pRBCs into preterm infants can be considered inappropriate for the physiology of a preterm infant. An absence of standardisation of transfusion protocols makes it difficult to compare and interpret pertinent clinical data, as reflected by unclear associations between pRBC transfusion and complications related to prematurity, such as bronchopulmonary dysplasia, neurodevelopmental impairment, retinopathy of prematurity, or necrotising enterocolitis. The difficulty in interpreting clinical data is further increased by differences in study designs that either overestimate pRBC-associated complications of prematurity or have not yet been designed to directly link pRBC transfusions to their respective complications. Thus, neonatal transfusion practice has become an ongoing difficulty, in which differences in transfusion guidelines hinder the ability to generate comparable clinical data, and heterogeneity in clinical data prevents the implementation of standardised transfusion protocols. To overcome these issues, novel approaches with biochemical-clinical translational designs could enable clinicians to gather causal evidence instead of circumstantial correlation.
早产儿在住院期间通常会接受成人浓缩红细胞（pRBC）输血。由于成人红细胞与早产儿红细胞有很大的不同，将成人 pRBC 输给早产儿可能不适合早产儿的生理状况。由于输血方案缺乏标准化，使得比较和解释相关的临床数据变得困难，这反映在 pRBC 输血与与早产相关的并发症之间的关联不明确，例如支气管肺发育不良、神经发育障碍、早产儿视网膜病变或坏死性小肠结肠炎。研究设计的差异进一步增加了解释临床数据的难度，这些差异要么高估了与 pRBC 相关的早产儿并发症，要么尚未设计用于直接将 pRBC 输血与其各自的并发症联系起来。因此，新生儿输血实践一直是一个难题，其中输血指南的差异阻碍了生成可比临床数据的能力，而临床数据的异质性又阻止了标准化输血方案的实施。为了克服这些问题，具有生化-临床转化设计的新方法可以使临床医生收集因果证据，而不是偶然关联。
