Department of Neonatology, Faculty of Pediatrics, Seventh Medical Center of PLA General Hospital, Beijing, China.
National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China.
JAMA Netw Open. 2022 Oct 3;5(10):e2237588. doi: 10.1001/jamanetworkopen.2022.37588.
Platelet transfusion is commonly performed in infants to correct severe thrombocytopenia or prevent bleeding. Exploring the associations of platelet transfusion, platelet count (PC), and mean platelet volume (MPV) with intraventricular hemorrhage (IVH) and in-hospital mortality in preterm infants can provide evidence for the establishment of future practices.
To evaluate the associations of platelet transfusion, PC, and MPV with IVH and in-hospital mortality and to explore whether platelet transfusion-associated IVH and mortality risks vary with PC and MPV levels at the time of transfusion.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included preterm infants who were transferred to the neonatal intensive care unit on their day of birth and received ventilation during their hospital stay. The study was conducted at a neonatal intensive care unit referral center in Beijing, China, between May 2016 and October 2017. Data were retrieved and analyzed from December 2020 to January 2022.
Platelet transfusion, PC, and MPV.
Any grade IVH, severe IVH (grade 3 or 4), and in-hospital mortality.
Among the 1221 preterm infants (731 [59.9%] male; median [IQR] gestational age, 31.0 [29.0-33.0] weeks), 94 (7.7%) received 166 platelet transfusions. After adjustment for potential confounders, platelet transfusion was significantly associated with mortality (hazard ratio [HR], 1.48; 95% CI, 1.13-1.93; P = .004). A decreased PC was significantly associated with any grade IVH (HR per 50 × 103/μL, 1.13; 95% CI, 1.05-1.22; P = .001), severe IVH (HR per 50 × 103/μL, 1.16; 95% CI, 1.02-1.32; P = .02), and mortality (HR per 50 × 103/μL, 1.74; 95% CI, 1.48-2.03; P < .001). A higher MPV was associated with a lower risk of mortality (HR, 0.83; 95% CI, 0.69-0.98; P = .03). The platelet transfusion-associated risks for both IVH and mortality increased when transfusion was performed in infants with a higher PC level (eg, PC of 25 × 103/μL: HR, 1.20; 95% CI, 0.89-1.62; PC of 100 × 103/μL: HR, 1.40; 95% CI, 1.08-1.82). The platelet transfusion-associated risks of IVH and mortality varied with MPV level at the time of transfusion.
In preterm infants, platelet transfusion, PC, and MPV were associated with mortality, and PC was also associated with any grade IVH and severe IVH. The findings suggest that a lower platelet transfusion threshold is preferred; however, the risk of a decreased PC should not be ignored.
血小板输注常用于纠正严重血小板减少症或预防出血。研究血小板输注、血小板计数（PC）和平均血小板体积（MPV）与早产儿脑室出血（IVH）和院内死亡率的相关性，可以为未来的实践提供证据。
评估血小板输注、PC 和 MPV 与 IVH 和院内死亡率的相关性，并探讨血小板输注相关的 IVH 和死亡率风险是否随输注时的 PC 和 MPV 水平而变化。
设计、地点和参与者：这是一项回顾性队列研究，纳入了在出生当天转入新生儿重症监护病房并在住院期间接受通气的早产儿。该研究在北京的一家新生儿重症监护病房转诊中心进行，时间为 2016 年 5 月至 2017 年 10 月。研究数据于 2020 年 12 月至 2022 年 1 月检索和分析。
血小板输注、PC 和 MPV。
任何级别 IVH、严重 IVH（3 级或 4 级）和院内死亡率。
在 1221 名早产儿中（731 名男性[59.9%]；中位[IQR]胎龄，31.0 [29.0-33.0] 周），94 名（7.7%）接受了 166 次血小板输注。在调整了潜在混杂因素后，血小板输注与死亡率显著相关（危险比[HR]，1.48；95%CI，1.13-1.93；P = .004）。较低的 PC 与任何级别 IVH（每 50×103/μL 的 HR，1.13；95%CI，1.05-1.22；P = .001）、严重 IVH（每 50×103/μL 的 HR，1.16；95%CI，1.02-1.32；P = .02）和死亡率（每 50×103/μL 的 HR，1.74；95%CI，1.48-2.03；P < .001）显著相关。较高的 MPV 与较低的死亡率风险相关（HR，0.83；95%CI，0.69-0.98；P = .03）。当在 PC 水平较高的婴儿中进行血小板输注时，血小板输注相关的 IVH 和死亡率风险增加（例如，PC 为 25×103/μL：HR，1.20；95%CI，0.89-1.62；PC 为 100×103/μL：HR，1.40；95%CI，1.08-1.82）。血小板输注相关的 IVH 和死亡率风险与输注时的 MPV 水平有关。
在早产儿中，血小板输注、PC 和 MPV 与死亡率相关，PC 也与任何级别 IVH 和严重 IVH 相关。研究结果表明，较低的血小板输注阈值是首选的；然而，不能忽视 PC 降低的风险。
