Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands.
Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
JAMA Netw Open. 2024 Sep 3;7(9):e2434077. doi: 10.1001/jamanetworkopen.2024.34077.
Red blood cell (RBC) transfusions are frequently administered to preterm infants born before 32 weeks of gestation in the neonatal intensive care unit (NICU). Two randomized clinical trials (Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants [ETTNO] and Transfusion of Prematures [TOP]) found that liberal RBC transfusion thresholds are nonsuperior to restrictive thresholds, but the extent to which these results have been integrated into clinical practice since publication in 2020 is unknown.
To describe neonatal RBC transfusion practice in Europe.
DESIGN, SETTING, AND PARTICIPANTS: This international prospective observational cohort study collected data between September 1, 2022, and August 31, 2023, with a 6-week observation period per center, from 64 NICUs in 22 European countries. Participants included 1143 preterm infants born before 32 weeks of gestation.
Admission to the NICU.
Study outcome measures included RBC transfusion prevalence rates, cumulative incidence, indications, pretransfusion hemoglobin (Hb) levels, volumes, and transfusion rates, Hb increment, and adverse effects of RBC transfusion.
A total of 1143 preterm infants were included (641 male [56.1%]; median gestational age at birth, 28 weeks plus 2 days [IQR, 26 weeks plus 2 days to 30 weeks plus 2 days]; median birth weight, 1030 [IQR, 780-1350] g), of whom 396 received 1 or more RBC transfusions, totaling 903 transfusions. Overall RBC transfusion prevalence rate during postnatal days 1 to 28 was 3.4 transfusion days per 100 admission days, with considerable variation across countries, only partly explained by patient mix. By day 28, 36.5% (95% CI, 31.6%-41.5%) of infants had received at least 1 transfusion. Most transfusions were given based on a defined Hb threshold (748 [82.8%]). Hemoglobin levels before transfusions indicated for threshold were below the restrictive thresholds set by ETTNO in 324 of 729 transfusions (44.4%) and TOP in 265 of 729 (36.4%). Conversely, they were between restrictive and liberal thresholds in 352 (48.3%) and 409 (56.1%) transfusions, respectively, and above liberal thresholds in 53 (7.3%) and 55 (7.5%) transfusions, respectively. Most transfusions given based on threshold had volumes of 15 mL/kg (470 of 738 [63.7%]) and were administered over 3 hours (400 of 738 [54.2%]), but there was substantial variation in dose and duration.
In this cohort study of very preterm infants, most transfusions indicated for threshold were given for pretransfusion Hb levels above restrictive transfusion thresholds evaluated in recent trials. These results underline the need to optimize practices and for implementation research to support uptake of evidence.
在新生儿重症监护病房（NICU）中，经常对出生于 32 周前的早产儿输注红细胞（RBC）。两项随机临床试验（极低出生体重儿输血阈值对神经认知结局的影响[ETTNO]和早产儿输血[TOP]）发现，宽松的 RBC 输血阈值并不优于严格的阈值，但自 2020 年发表以来，这些结果在多大程度上已融入临床实践尚不清楚。
描述欧洲新生儿 RBC 输血实践。
设计、设置和参与者：这项国际前瞻性观察性队列研究于 2022 年 9 月 1 日至 2023 年 8 月 31 日期间收集数据，每个中心的观察期为 6 周，来自欧洲 22 个国家的 64 个 NICU。参与者包括 1143 名出生于 32 周前的早产儿。
入住 NICU。
研究的结局测量包括 RBC 输血的流行率、累积发生率、适应证、输血前血红蛋白（Hb）水平、体积和输血率、Hb 增加和 RBC 输血的不良反应。
共纳入 1143 名早产儿（641 名男性[56.1%]；中位胎龄为 28 周加 2 天[IQR，26 周加 2 天至 30 周加 2 天]；中位出生体重为 1030[IQR，780-1350]g），其中 396 名接受了 1 次或多次 RBC 输血，共 903 次输血。在出生后 1 至 28 天期间，RBC 输血的总体流行率为每 100 个入院日输血 3.4 天，各国之间存在较大差异，部分原因是患者人群的差异。到第 28 天，36.5%（95%CI，31.6%-41.5%）的婴儿至少接受了 1 次输血。大多数输血是根据明确的 Hb 阈值进行的（748[82.8%]）。为阈值输血的指示性 Hb 水平低于 ETTNO 在 729 次输血中的 324 次（44.4%）和 TOP 在 729 次输血中的 265 次（36.4%）设定的限制性阈值。相反，在 352 次（48.3%）和 409 次（56.1%）输血中，它们分别位于限制性和宽松阈值之间，在 53 次（7.3%）和 55 次（7.5%）输血中，它们分别高于宽松阈值。大多数基于阈值的输血体积为 15mL/kg（738 次中的 470 次[63.7%]），持续时间为 3 小时（738 次中的 400 次[54.2%]），但剂量和持续时间存在很大差异。
在这项对非常早产儿的队列研究中，大多数基于阈值的输血都是在最近的试验中评估的限制性输血阈值以上的输血前 Hb 水平指示的。这些结果强调需要优化实践，并进行实施研究，以支持证据的采用。
