Department of Pediatrics, Division of Neonatology, Children's Hospital of Georgia, Augusta, Georgia, USA.
Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, Augusta, Georgia, USA.
Transfusion. 2022 Nov;62(11):2254-2261. doi: 10.1111/trf.17097. Epub 2022 Sep 5.
Blood product transfusions are necessary for critically ill neonates on extracorporeal membrane oxygenation (ECMO). Transfusions are administered in response to unstudied arbitrary thresholds and may be associated with adverse outcomes. The objective of this study was to identify relationships between blood product components and mortality in neonates receiving ECMO support for respiratory indications.
A retrospective review of neonates receiving ECMO for respiratory indications from 2002 to 2019 from a single quaternary-referral neonatal intensive care unit (NICU). Demographic and outcome data and transfusion volume (ml/kg/day) were harvested from the medical record, and baseline mortality risk was assessed using NEO-RESCUERS scores. The association between volume of red blood cells (RBC), platelet, plasma transfusion rates (ml/kg/day), and mortality on ECMO were assessed after adjustment for NEO-RESCUERS score. Cox proportional hazards (CPH) competing risk model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for each variable and mortality outcome.
Among 248 neonates undergoing ECMO for respiratory failure, overall survival was 93%. RBC, platelet, and plasma volume were highly associated with mortality during ECMO in an unadjusted model. After adjusting for NEO-RESCUERS score, RBC volume was associated with increased mortality risk (HR 1.013, 95% CI 1.004-1.022, p = .0043), but platelet and plasma volume were not associated with mortality.
RBC, but not platelet or plasma volume, is associated with mortality in neonates on ECMO. Our findings refute previous studies demonstrating an association between platelet volume and mortality for neonates on ECMO.
体外膜肺氧合（ECMO）支持下的危重新生儿需要输血治疗。输血是根据未研究的任意阈值进行的，可能与不良结局有关。本研究的目的是确定接受 ECMO 支持治疗呼吸指征的新生儿的血液成分与死亡率之间的关系。
对 2002 年至 2019 年期间在单所四级转诊新生儿重症监护病房（NICU）接受 ECMO 支持治疗呼吸指征的新生儿进行回顾性研究。从病历中提取人口统计学和结局数据以及输血量（ml/kg/天），并使用 NEO-RESCUERS 评分评估基线死亡率风险。在调整 NEO-RESCUERS 评分后，评估红细胞（RBC）、血小板、血浆输注率（ml/kg/天）与 ECMO 死亡率之间的关系。使用 Cox 比例风险（CPH）竞争风险模型估计每个变量和死亡率结局的风险比（HR）和 95%置信区间（CI）。
在 248 例因呼吸衰竭而行 ECMO 的新生儿中，总体生存率为 93%。在未调整模型中，RBC、血小板和血浆量与 ECMO 期间的死亡率高度相关。在调整 NEO-RESCUERS 评分后，RBC 量与死亡率增加相关（HR 1.013，95% CI 1.004-1.022，p=0.0043），但血小板和血浆量与死亡率无关。
在 ECMO 支持下的新生儿中，RBC 与死亡率相关，但血小板或血浆量与死亡率无关。我们的研究结果反驳了先前表明血小板量与 ECMO 新生儿死亡率相关的研究。
