Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Blood Purif. 2024;53(8):665-675. doi: 10.1159/000538010. Epub 2024 Mar 1.
The incidence of thrombocytopenia in neonates receiving extracorporeal membrane oxygenation (ECMO) with and without concurrent continuous renal replacement therapy (CRRT) and associated complications have not been well described. The primary aims of the current study were to (1) characterize thrombocytopenia in neonates receiving ECMO (including those treated concurrently with CRRT) and (2) evaluate risk factors (including CRRT utilization) associated with severe thrombocytopenia. In a planned exploratory secondary aim, we explored the association of severe thrombocytopenia with outcomes in neonates receiving ECMO.
We conducted a retrospective single-center chart review of neonates who received ECMO 07/01/14-03/01/20 and evaluated associations between CRRT, severe thrombocytopenia (platelet count <50,000/mm3), and outcomes (ECMO duration, length of stay, and survival).
Fifty-two neonates received ECMO; 35 (67%) received concurrent CRRT. Severe thrombocytopenia occurred in 27 (52%) neonates overall and in 21 (60%) neonates who received concurrent CRRT. Underlying diagnosis, ECMO mode, care unit, and moderate/severe hemolysis differed between those who did and did not receive CRRT. CRRT receivers experienced shorter hospital stays than CRRT non-receivers, but ECMO duration, length of intensive care unit (ICU) stay, and survival did not differ between groups. CRRT receipt was associated with severe thrombocytopenia. Exploratory classification and regression tree (CART) analysis suggests CRRT use, birthweight, and ICU location are all predictors of interest for severe thrombocytopenia.
In our cohort, CRRT use during ECMO was associated with severe thrombocytopenia, and patients who received ECMO with CRRT experienced shorter hospital stays than those who did not receive CRRT. Exploratory CART analysis suggests CRRT use, birthweight, and ICU location are all predictors for severe thrombocytopenia and warrant further investigations in larger studies.
接受体外膜氧合（ECMO）治疗的新生儿中血小板减少症的发生率，以及同时接受持续肾脏替代治疗（CRRT）和相关并发症的发生率尚未得到很好的描述。本研究的主要目的是：（1）描述接受 ECMO 治疗的新生儿（包括同时接受 CRRT 治疗的新生儿）的血小板减少症特征；（2）评估与严重血小板减少症相关的危险因素（包括 CRRT 的使用）。在计划的探索性次要目标中，我们探讨了严重血小板减少症与接受 ECMO 治疗的新生儿结局之间的关联。
我们对 2014 年 7 月 1 日至 2020 年 3 月 1 日期间接受 ECMO 治疗的新生儿进行了回顾性单中心图表回顾，并评估了 CRRT、严重血小板减少症（血小板计数 <50,000/mm3）与结局（ECMO 持续时间、住院时间和存活率）之间的关系。
52 名新生儿接受了 ECMO；35 名（67%）同时接受了 CRRT。严重血小板减少症在 52%的新生儿中发生，在同时接受 CRRT 的 60%的新生儿中发生。在接受和不接受 CRRT 的新生儿中，基础诊断、ECMO 模式、护理单元以及中度/重度溶血不同。接受 CRRT 的新生儿比不接受 CRRT 的新生儿住院时间更短，但两组之间 ECMO 持续时间、重症监护病房（ICU）住院时间和存活率没有差异。CRRT 的使用与严重血小板减少症相关。探索性分类回归树（CART）分析表明，CRRT 的使用、出生体重和 ICU 位置均为严重血小板减少症的相关预测因素。
在我们的队列中，ECMO 期间使用 CRRT 与严重血小板减少症相关，接受 ECMO 联合 CRRT 治疗的患者比未接受 CRRT 治疗的患者住院时间更短。探索性 CART 分析表明，CRRT 的使用、出生体重和 ICU 位置均为严重血小板减少症的预测因素，需要在更大的研究中进一步探讨。
