Ohls Robin K, Bahr Timothy M, Peterson Thomas G, Christensen Robert D
Division of Neonatology, Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
Division of Neonatology, Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA; Women and Newborns Research, Intermountain Health, Murray, UT, USA.
Semin Fetal Neonatal Med. 2025 Mar;30(1):101545. doi: 10.1016/j.siny.2024.101545. Epub 2024 Oct 22.
Red blood cell transfusions can be lifesaving for neonates with severe anemia or acute massive hemorrhage. However, it is imperative to understand that red cell transfusions convey unique and significant risks for neonates. The extremely rare risks of transmitting a viral, bacterial, or other microbial infection, or causing circulatory overload are well known and are part of blood transfusion informed consent. Less well known, and not always part of the consent process, are more common risks of transfusing the smallest and most immature NICU patients; specifically, multiple transfusions may worsen inflammatory conditions (particularly pulmonary inflammation), and in certain subsets are associated with retinopathy of prematurity and neurodevelopmental delay. Instituting non-pharmacological transfusion-avoidance techniques reduces transfusion rates. Pharmacological transfusion-avoidance, specifically erythropoietic stimulating agents, further reduces the risk of needing a transfusion. The protocols described herein constitute an efficient and cost-effective transfusion-avoidance program. Using these protocols, many NICU patients can remain transfusion-free.
红细胞输血对于患有严重贫血或急性大出血的新生儿可能是救命的。然而，必须明白红细胞输血给新生儿带来了独特且重大的风险。传播病毒、细菌或其他微生物感染，或导致循环超负荷等极其罕见的风险是众所周知的，并且是输血知情同意书的一部分。不太为人所知且并非总是在同意过程中的是，给最小且最不成熟的新生儿重症监护病房（NICU）患者输血的更常见风险；具体而言，多次输血可能会加重炎症状况（尤其是肺部炎症），并且在某些亚组中与早产儿视网膜病变和神经发育延迟有关。采用非药物性输血避免技术可降低输血率。药物性输血避免，特别是促红细胞生成刺激剂，进一步降低了需要输血的风险。本文所述的方案构成了一个高效且具有成本效益的输血避免计划。使用这些方案，许多NICU患者可以避免输血。
