Division of Newborn Medicine, Boston Childrens Hospital, Boston, Massachusetts.
Division of Neonatology, University of Washington, Seattle.
JAMA Netw Open. 2024 Jan 2;7(1):e2352394. doi: 10.1001/jamanetworkopen.2023.52394.
Infants born extremely preterm receive transfusions at higher platelet count thresholds than older children and adults due to concerns for intracranial hemorrhage. A recent randomized trial comparing 2 platelet transfusion thresholds showed the higher threshold was associated with increased risk of long-term adverse neurodevelopmental outcomes.
To evaluate the association of platelet transfusion exposure with death and severe neurodevelopmental impairment (NDI) at 2 years' corrected age in a cohort of infants born extremely preterm.
DESIGN, SETTING, AND PARTICIPANTS: An observational cohort study and secondary analysis of the Preterm Erythropoietin Neuroprotection Trial, a randomized, placebo-controlled clinical trial of erythropoietin neuroprotection in neonates born extremely preterm, was conducted in 30 neonatal intensive care units in the US from December 1, 2013, to September 31, 2016. This analysis included 819 infants born extremely preterm at 24 to 27 completed weeks of gestation who had a documented outcome (death or neurodevelopmental assessment). Analysis was performed in April 2023.
Any platelet transfusion during neonatal intensive care unit hospitalization.
The primary composite outcome was death or severe NDI evaluated at 2 years' corrected age using the Bayley Scales of Infant Development-Third Edition (BSID-III) and the Gross Motor Function Classification System and was defined as the presence of severe cerebral palsy or a BSID-III composite motor or cognitive score 2 SDs below the mean. Confounding by indication for platelet transfusion was addressed with covariate adjustment and propensity score methods.
Of the 819 infants included in the analysis (429 [52.4%] male; mean [SD] gestational age, 25.5 [1.1] weeks), 245 (30.0%) received at least 1 platelet transfusion during their initial hospitalization. The primary outcome occurred in 46.5% (114 of 245) of infants exposed to a platelet transfusion and 13.9% (80 of 574) of nonexposed infants with a corresponding odds ratio of 2.43 (95% CI, 1.24-4.76), adjusted for propensity score, gestational age at birth, and trial treatment group. The individual components of death and severe NDI were directionally consistent with the overall composite outcome.
The findings of this study suggest that platelet transfusion in infants born extremely preterm may be associated with an increased risk of death or severe NDI at 2 years' corrected age, although the possibility of residual confounding by indication cannot be excluded.
由于担心颅内出血，极早产儿接受的输血血小板计数阈值高于较大儿童和成人。最近一项比较两种血小板输血阈值的随机试验表明，较高的阈值与长期不良神经发育结局的风险增加有关。
在一个极早产儿队列中评估血小板输注暴露与死亡和 2 年校正年龄时严重神经发育障碍（NDI）的关系。
设计、地点和参与者：这是一项观察性队列研究和 Preterm Erythropoietin Neuroprotection Trial 的二次分析，该试验是一项新生儿期极早产儿促红细胞生成素神经保护的随机、安慰剂对照临床试验，在美国 30 个新生儿重症监护病房进行，时间为 2013 年 12 月 1 日至 2016 年 9 月 31 日。本分析纳入了 819 名在 24 至 27 周胎龄时极早产儿出生的婴儿，他们有记录的结果（死亡或神经发育评估）。分析于 2023 年 4 月进行。
新生儿重症监护期间的任何血小板输注。
主要复合结局是在 2 年校正年龄时使用贝利婴幼儿发展量表第三版（BSID-III）和粗大运动功能分类系统评估的死亡或严重 NDI，定义为严重脑瘫或 BSID-III 复合运动或认知评分低于均值 2 个标准差。通过协变量调整和倾向评分方法解决了血小板输注的指示性混杂问题。
在分析中纳入的 819 名婴儿中（429 [52.4%] 为男性；平均[标准差]胎龄为 25.5[1.1]周），有 245 名（30.0%）在初始住院期间接受了至少 1 次血小板输注。暴露于血小板输注的婴儿中有 46.5%（114 例）发生主要结局，而未暴露于血小板输注的婴儿中有 13.9%（80 例）发生主要结局，相应的比值比为 2.43（95%CI，1.24-4.76），调整了倾向评分、出生时胎龄和试验治疗组。死亡和严重 NDI 的各个组成部分与整体复合结局的方向一致。
这项研究的结果表明，极早产儿的血小板输注可能与 2 年校正年龄时的死亡或严重 NDI 风险增加有关，尽管不能排除指示性残留混杂的可能性。
Zotero 插件
