Department of Neonatology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Department of Neonatology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Transfus Apher Sci. 2023 Dec;62(6):103839. doi: 10.1016/j.transci.2023.103839. Epub 2023 Oct 24.
The purpose of this study was to investigate and compare the effects of 20 ml/kg and 15 ml/kg red blood cell transfusion (RBCT) on cerebral and intestinal tissue oxygenation, the number of administered transfusions, and neonatal complications in premature infants with anemia.
This prospective, randomized, partially blinded observational study investigated anemic neonates of gestational age < 32 weeks (Registration ID: ChiCTR 1,900,026,672). The infants were randomly assigned to receive 15 or 20 ml/kg red blood cell transfusion. Cerebral and intestinal tissue oxygen saturation (cer rSO and int rSO) were collected 2 h before transfusion, 2, 4, 6, 12, 24, and 48 h after the beginning of transfusion by Near-infrared spectroscopy (NIRS). We also collected vital signs including heart rate (HR), peripheral oxygen saturation (SpO), and mean arterial blood pressure (MABP) 2 h before infusion, 2 h, and 6 h after the beginning of transfusion. Then we analyzed and compared regional oxygen saturation(rSO) fractional tissue oxygen extraction (FTOE), and other outcome readouts (blood transfusion numbers, changes in hematocrit and hemoglobin, hospitalization days, HR, SpO2, MABP, and complications) between the two groups. The intraindividual comparisons of the above readouts before transfusion and those after transfusion were also evaluated within each group.
73 newborns received 20 ml/kg (large volume group) and 78 newborns received 15 ml/kg transfusion (small volume group). There was no significant difference in cer rSO2, int rSO, Cerebral fractional tissue oxygen extraction (cFTOE), and intestinal fractional tissue oxygen extraction (iFTOE) between the two groups. rSO MABP, and SpO increased; HR, cFTOE, and iFTOE decreased following transfusion in both groups. The transfusion number of the large volume group is significantly less than that of the small volume group (1.9 ± 0.3 vs. 2.6 ± 0.9, p < 0.01) and hospitalization days were also less than those in the low volume group (44.3 ± 8.2 vs. 47.6 ± 9.8, p < 0.05). The increases in hematocrit and hemoglobin were higher in the large volume group than those in small volume (hematocrit increment (%),10.7 ± 4.2 vs. 10.1 ± 5.9, p = 0.015; Hb concentration after blood transfusion (g/L) 132.3 ± 11.1 vs. 127.4 ± 15.4, p = 0.028).
After the transfusion, cer rSO2 and int rSO increased significantly, FTOE decreased and vital signs improved in both the 15 ml/kg and 20 ml/kg groups, and these changes were not significantly different between the two groups. However, the larger group showed a more pronounced increase in hematocrit and hemoglobin, a reduction in the total number of transfusions, and a shorter duration of hospitalization after transfusion in preterm infants without increasing complications.
本研究旨在调查和比较 20ml/kg 和 15ml/kg 红细胞输注（RBCT）对贫血早产儿脑和肠组织氧合、输注次数和新生儿并发症的影响。
这是一项前瞻性、随机、部分盲法观察性研究，纳入胎龄<32 周的贫血早产儿（注册号：ChiCTR1900026672）。婴儿被随机分配接受 15 或 20ml/kg 的红细胞输注。输注前 2h、输注开始后 2、4、6、12、24 和 48h 通过近红外光谱（NIRS）采集脑和肠组织氧饱和度（cer rSO 和 int rSO）。我们还采集生命体征，包括输注前 2h、输注开始后 2h 和 6h 的心率（HR）、外周血氧饱和度（SpO）和平均动脉血压（MABP）。然后，我们分析比较了两组间输注前后区域氧饱和度（rSO）、氧分数组织提取（FTOE）和其他转归指标（输血次数、红细胞压积和血红蛋白变化、住院天数、HR、SpO2、MABP 和并发症）。还评估了每组内输注前后上述指标的个体内比较。
73 名新生儿接受 20ml/kg（大体积组），78 名新生儿接受 15ml/kg 输血（小体积组）。两组间 cer rSO2、int rSO、脑分数组织氧提取（cFTOE）和肠分数组织氧提取（iFTOE）无显著差异。两组输血后 rSO、MABP 和 SpO 增加，HR、cFTOE 和 iFTOE 降低。大体积组的输血次数明显少于小体积组（1.9±0.3 与 2.6±0.9，p<0.01），住院天数也少于小体积组（44.3±8.2 与 47.6±9.8，p<0.05）。大体积组的红细胞压积和血红蛋白升高幅度高于小体积组（红细胞压积升高（%），10.7±4.2 与 10.1±5.9，p=0.015；输血后血红蛋白浓度（g/L），132.3±11.1 与 127.4±15.4，p=0.028）。
输血后，两组 15ml/kg 和 20ml/kg 红细胞输注后 cer rSO2 和 int rSO 均显著升高，FTOE 降低，生命体征改善，两组间无显著差异。然而，大体积组在输血后表现出更明显的红细胞压积和血红蛋白升高、总输血次数减少和住院时间缩短，且不增加并发症。
